Case Study:
Mr. Rodriguez & Cardiovascular Disease

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What should be the initial treatment intervention?

Fast Fact Treat the ABCs A1C Blood Pressure Cholesterol

• Aspirin
• Heparin
• ACE inhibitor
• Beta blocker
• PTCA/stent to the right coronary artery
• Intravenous drip insulin
• Weight reduction
• Referral to dietitian for nutrition counseling
• Recommendation for increased physical activity

What general interventional strategies would you begin?

• Intervention 1 = Multiple-dose insulin alone program
• Intervention 2 = Multiple-dose insulin program + insulin sensitizer
• Intervention 3 = Dual-action combination oral agents (2-3) (secretagogue + insulin sensitizer) ± long-acting insulin

Referral to diabetes educator

Exercise for cardiac rehabilitation

Prevention of recurrent myocardial infarction (MI) with lifestyle changes and medications

What is the suggested follow-up?

• Follow-up within two weeks following discharge

Review self-monitoring blood glucose (SMBG) data

Adjust insulin therapy

Instruct in treat-to-target approach

Instruct in carbohydrate-to-insulin ratio and its use in intensified management (carbohydrate counting)

• Monthly visits for next four months to continue intensified management
• Quarterly visits thereafter
• SMBG data reviewed biweekly (fax or email)