Key Feature Problems - CASE 1 Type II Diabetes

Mr Smith is a 50 yo male and have been diagnosed with NIDDM for the last 5 years.  He has just moved to the area and starts seeing you as his new Doctor.  His most recent bloods shows a HbA1c of 9%, Cholesterol of 6, TG 3, HDL 0.9, and LDL 3.  His BP is 145/90.  He smokes 10 cigarettes/day.  His BMI is 30.   He is currently taking Metformin XR 1000mg nocte, lipitor 40mg and ramipril 2.5mg/day

Question 1
What other investigation results would you like to find out in order to manage his condition more effectively at this point.  Fill in up to 5 from the following list.
                               
0  TSH                                                                                                          
0  Renal function: creatinine clearance                     
0  B12 and folate                                                         
0  ECG                                                                      
0  Renal USS                                                            
0  CK                                                                        
0  Urine 24 hour protein/albumin                                
0  FBC                                                                         
0  MSU                                                                        
0  Chest Xray                                                              
0  24 hour BP result
0  Liver function test
0  Serum electrolytes
0  Nerve conduction studies
0  Renal doppler USS
0  Cardiac echo
0  Waist circumference  

Question 2
What action would you consider?
List, in note form, up to four (4) steps.

1.  _______________________________________________________________________________

2.  _______________________________________________________________________________

3.  _______________________________________________________________________________

4.  _______________________________________________________________________________


Question 3
What BP target are you aiming for in this patient assuming that there is no proteinuria?

1.  _______________________________________________________________________________

Please answer in the comment link below and I will give you feedback.

Copyright written by Dr Vin
Reference NPS Type 2 Diabetes: Priorities and Targets.  2012.