1 / 27

Management of Diabetes and Familial Hypertriglyceridemia in a 35-Year-Old Male

This case study focuses on a 35-year-old male with diabetes and familial hypertriglyceridemia who is noncompliant with his medications. The case highlights the importance of addressing noncompliance, diet, and restarting necessary medications for optimal management.

dricardo
Download Presentation

Management of Diabetes and Familial Hypertriglyceridemia in a 35-Year-Old Male

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 35 Year Old Male with Diabetes and Familial Hypertriglyceridemia, Medication noncompliance Case Categories Primary Prevention Secondary Prevention Pediatric Case Familial Hypertriglyceridemia Diabetes Metabolic Syndrome Low HDL Familial Combined Hyperlipidemia Familial Hypercholesterolemia Elevated Lipoprotein (a) Statin Intolerance Case category: Diabetes, Familial Hypertriglyceridemia History of present illness: 35 year old male with diabetes and familial hypertriglyceridemia. Well controlled on Crestor 20, Niaspan 2000, Lovaza 6, metformin ER 2000, Actos 15, Victoza 1.8 and Cycloset 0.8 (LDL-P: 605, total cholesterol: 91, triglycerides: 121, HDL: 35.) Off medications for only 6 days prior to 3 month follow-up labs, lipid profile deteriorated. Here for follow-up visit.

  2. Patient Information

  3. Patient History

  4. Current Medications

  5. Lipid Profile Off Medications for 6 Days Fasting: F NT = Not Tested

  6. Other Labs Worth Noting Off Medications for 6 Days Fasting: F NT = Not Tested

  7. Labs Off Medications for 6 Days (1 of 5) Note extremely elevated fasting triglycerides.

  8. Labs Off Medications for 6 Days (2 of 5)

  9. Labs Off Medications for 6 Days (3 of 5)

  10. Labs Off Medications for 6 Days (4 of 5)

  11. Labs Off Medications for 6 Days (5 of 5)

  12. NMR LipoProfile • Insert NMR Lipoprofile 020812 PW76 Insert

  13. Questions to Consider Question 1: Assess reason for noncompliance. Fear of side effects? Each medication should be addressed. Is cost an issue? (He reports he just ran out of medications and figured a week off them would not affect his numbers.) Question 2: Address diet. Following a low carb diet is very important in setting of diabetes not optimally controlled (HbA1C 7.7).

  14. Initial Treatment & Management Restart Crestor 20, Niaspan 2000 and Lovaza 6 for hypertriglyceridemia. Restart metformin 2000, Victoza 1.8 and Cycloset 0.8 for diabetes control. It is acceptable to not restart Actos for now. Restart CO Q 10 300-600 mg/day for muscle aching which has given him symptom relief in past. Restart Vitamin D2 50,000 IU weekly and Vitamin D3 5000 IU daily for vitamin D deficiency.

  15. Discussion (1 of 3) Risk Factors: Premature family history of heart disease/stroke, Diabetes, Hypertension, Hyperlipidemia Assessment: Familial Hypertriglyceridemia

  16. Discussion (2 of 3) Assessment: Diabetes Type II

  17. Discussion (3 of 3) Assessment: Vitamin D Deficiency

  18. Follow Up on Crestor 20, Niaspan 2000, Lovaza 6, Metformin 2000, Victoza 1.8, Cycloset 0.8 and Vitamin D2 50,000 / D3 5000 (1 of 2) • Familial Combined hypertriglyceridemia – Improved. • Restarted Crestor 20, Niaspan 2000 and Lovaza 6. • LDL-P is now reduced from 1405 to 655. Total cholesterol is reduced from 279 to 84. Triglycerides dropped from 1072 to 252. HDL is now 30. IR Score was reduced from 100 to 74. • Continue therapy. • Diabetes Type 2 – Unchanged. • Restarted metformin 2000, Victoza 1.8 and Cycloset 0.8. • HbA1C remained the same at 7.7. • IR Score did lower from 100 to 74. Optimal is <45. • Continue therapy.

  19. Follow Up on Crestor 20, Niaspan 2000, Lovaza 6, Metformin 2000, Victoza 1.8, Cycloset 0.8 and Vitamin D2 50,000 / D3 5000 (2 of 2) • Vitamin D Deficiency – Improved. • Restarted vitamin D2 50,000 IU weekly and started vitamin D3 5000 IU/day. • Levels increased from 12 to 54. • Continue therapy.

  20. Follow Up Labs on Medications (1 of 4)

  21. Follow Up Labs on Medications (2 of 4)

  22. Follow Up Labs on Medications (3 of 4)

  23. Follow Up Labs on Medications (4 of 4)

  24. NMR LipoProfile Insert NMR Lipoprofile 030612 PW76 Insert

  25. Collaborative Treatment ApproachEmpower Patient for Self-Care • Interventions that empower patients help them make informed, self-directed decisions and manage their diabetes in a way that works for their lives. Assessment of self-management beliefs, behavior, and knowledge Collaborative goal setting Individually tailored strategies and problem solving Personal Action Plan Identification of personal barriers and supports Funnell MM. Eur J Endocrinol. 2004. Oct;151 Suppl2:T19-22. Denver, EA et al. Diabetes Care. 2003 Aug;26(8):2256-60.

  26. Work Together to Prioritize Treatment Goals and Establish Good Self-Care Agree on an agenda by using communication strategies that avoid overwhelming newly diagnosed patients with “too much, too soon” Exchange Information Multiple Behaviors Explore Importance Establish Rapport Set Agenda Single Behavior Assess Importance and Confidence Readiness Build Confidence Reduce Resistance Rollnick S, Mason P, and Butler C. Health behavior change: a guide for practitioners. Edinburgh, Scotland: Churchill Livingstone, 2000.

  27. Case Summary

More Related