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Actively Engaging the Older Adult in Self Care of Diabetes

Actively Engaging the Older Adult in Self Care of Diabetes. John Devlin, MD Joel Botler, MD Mary Harkins Becker, MD. New York Times 2/5/06: “Diabetic Brothers Beat the Odds”. Case # 1: Sister Katherine. 82 years old DM II x 15 yrs S/P AMI x ? Yrs Htn Osteoporosis ? Mild dementia.

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Actively Engaging the Older Adult in Self Care of Diabetes

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  1. Actively Engaging the Older Adult in Self Care of Diabetes John Devlin, MD Joel Botler, MD Mary Harkins Becker, MD

  2. New York Times 2/5/06: “Diabetic Brothers Beat the Odds”

  3. Case # 1: Sister Katherine • 82 years old • DM II x 15 yrs • S/P AMI x ? Yrs • Htn • Osteoporosis • ? Mild dementia

  4. Case #1: Sister Katherine • She lives semi independently in a convent • She is a nonsmoker • She actively tends the convent garden, but does not get other regular exercise • She does like to snack on sweets at night

  5. ASA Lopressor Glucophage Fosomax Zestril Lipitor Tums Sister Katherine’s med list:

  6. Sister Katherine’s recent blood sugars: • 7am 120-150 • 12noon 140-180 • 5pm 140-180 • 8pm 150-220

  7. Sister Katherine’s recent data: • HbA1C=8.6 • LDL: 125 • Cr 1.0 • Microalbumin 88mcg/mg

  8. Sister Katherine: • BP 148/78, HR 62 • BMI: 21, weight: 55 kg • She tells you she fatigues too quickly

  9. What are reasonable treatment goals for sister Katherine? • BG? • HbA1C? • LDL? • Patient self management goal? • Other?

  10. Please address each of the following in today’s 15 minute office visit: • Nutrition • Exercise • Medications • Monitoring • Diabetes Education • Preventing Complications • Other medical issues!

  11. How can we actively engage Sister Katherine in caring for her diabetes?

  12. Case # 2: Mr. Leveque • 72 years old • DM II x 6 years • COPD • Htn • Depression • Gait instability • Chronic pain • Neuropathy

  13. Case # 2: Mr. Leveque • He lives alone • His wife dies one year ago • He checks his sugars regularly • He quit smoking 10 years ago • He does not exercise and has gained 10 kgs since his wife died

  14. Glyburide Wellbutrin Ativan Atenolol ASA Darvocet Pepcid HCTZ Neurontin Prednisone, prn Albuterol atrovent Mr. Leveque’s med list:

  15. Mr. Leveque’s blood sugars: • 8 am: 150-200 • 12 noon: 110-150 • 5 pm: 70-120 • 10 pm: 130-180

  16. Mr. Leveque’s recent data: • BP 178/82, HR 82 • LDL: 88 • HbA1C: 8 • BMI 30, weight 120 kg • Microalbumin 50 mcg/mg • Cr 1.2

  17. What are reasonable treatment goals for Mr. Leveque? • FBS? • HbA1C? • LDL? • Patient self management goal? • Other?

  18. How can we actively engage Mr. Leveque in caring for his diabetes?

  19. Case # 3: Mrs. Jones • 88 year old • Newly dx DM II • s/p breast CA 5 yr ago • h/o PVD, MI, CHF, urinary incontinence • Recent 2nd hosp. for CHF

  20. Case # 3: Mrs. Jones • Lives in assisted living • Is a nonsmoker • Is having a harder time getting around • Uses a walker but gets short of breath easily • Gets confused by her meds, but does try to take them

  21. ASA Toprol Lipitor Tamoxifen darvocet Spironolactone Nitro Lisinopril Lasix Mrs. Jone’s med list

  22. Mrs. Jone’s recent blood sugars: • 7am: 145-180 • 12 noon: 160-200 • 6 pm: 180-220

  23. Mrs. Jone’s recent data: • BP 133/62, HR 55 • LDL: 105 • HbA1C: 9 • BMI: 27, weight 85 kg • Cr 2.4 • UA 2+ protein

  24. What are reasonable treatment goals for Mrs. Jones? • FBS? • HbA1C? • LDL? • Patient self management goal? • Other?

  25. How can we actively engage Mrs. Jones in caring for her diabetes?

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