[Expert Solution]: Mrs

Mrs. SW returns to the diabetes service after one year. She has been in several times over the past year, and you now have a positive relationship with her. She has just been to see her physician for her yearly blood work. The physician has told her that her glucose is still a little high but much better and to keep up the good work. He added the Altace to her regimen. She has been on Diamicron and Lipitor for 6 months now. FPG 7.9 mmol/L A1C 7.8% BMI 30 Waist circumference 102 cm LDL 2.2mmol/L Triglycerides 2.6 mmol/L BP 140/85 Medications: metformin 1000 BID Diamicron MR 120 mg daily Lipitor 10 mg daily Effexor XR 75 mg daily hydrochlorothiazide 25 mg daily Altace 10 mg daily She has been using a home capillary blood glucose meter 3 days a week. Results are as follows: mmol/l Fasting after Breakfast Before Lunch After lunch Before supper After supper Bedtime Day 1 9.8 8.6 Day 2 Day 3 9.1 9.1 Day 4 Day 5 8.8 8.2 Day 6 Day 7 Mrs. SW is frustrated because she has implemented some of the ideas and strategies she had discussed with the dietitian, and she had joined a walking group. She walks with them 2 days a week for an hour at a time. She says she is trying hard but every time she goes to the physician, he adds more medication, and she is getting tired of all these pills. 1. What concerns do you have with her results? 2. What sort of nutrition assessment did you do? How did you support her around nutrition? How did she respond? 3. What lifestyle counseling did you attempt? And how did you approach the discussion? 4. Did you discuss any change in the diabetes medication? If so, what and how did you approach it given that you cannot prescribe? What was her response? (It is important to try to make a suggestion here and give rationale). 5. How and who did you consult in the interdisciplinary team? 6. How did you address the area of complications of diabetes? Her response? 7. What plans did you make with Mrs. SW to further her diabetes management? 8. Answer questions in detailed interview dialogue way and elaborate each questions