Case 1: New-Onset Type 2 Diabetes With Advanced Insulin Deficiency

Mrs. S is a 48-year-old obese woman who presents to her primary care physician (PCP) with vaginal itching and dysuria. She is a smoker with a family history of heart disease. On further questioning, she gives a history of 2 months of polyuria and polydipsia, and weight loss of more than 12 pounds without dieting

• Initial lab results: Random fingerstick 423 mg/dL; BP 140/95 mm Hg
• Diagnosis: type 2 diabetes
• Hypertension: Rx angiotensin-converting enzyme inhibitor (ACE-I)
• Candidal vaginitis: Rx fluconazole
• Plan: Draw blood for chemistry panel

Treatment Options to Control Blood Glucose

Participants are encouraged to read through all the treatment options for feedback on the benefits and/or limitations of each.

Treatment Option A: No Pharmacotherapy at This Time
Refer to diabetes educator for patient education on the importance of diet and exercise. Teach patient how to self-monitor blood glucose (SMBG).

Treatment Option B: Oral Antidiabetes Medication

1. Insulin secretagogue: sulfonylurea or meglitinides (eg, glipizide extended release, glimepiride, repaglinide, nateglinide)


2. Insulin sensistizer: metformin (eg, Glucophage)


3. Thiazolidinedione (pioglitazone or rosiglitazone)

Treatment Option C: Basal Insulin (eg, glargine, NPH)

Treatment Option D: Premixed Human Insulin or Analog Insulin Mix

Treatment Option E: Basal Insulin Replacement in Combination With Fast-Acting Insulin at Mealtimes

Treatment Option F: Regular Insulin According to “Sliding Scale” (ie, for blood sugars >200 mg/dL)

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