Caso clnico 2
Hombre
60 aos
Metformina 850 mg 1-1-1
Glimepirida 4 mg
Enalapril 20 mg 1-0-0
Simvastatina 40 mg 0-0-1
AAS 100 mg 0-1-0.
8,9 %
Glucemia basal
230 mg/dl
Colesterol total
210 mg/dl
Colesterol HDL
47 mg/dl
MDRD
65 mg/dl
Cociente albmina/creatinina
35 mg/g
ECG:
RS sin alteraciones
Otros datos:
? Antecedentes familiares:
? Madre diabtica.
? Antecedentes personales:
? Autnomo para las actividades de la vida diaria
? 15 aos desde que se le realiz el diagnstico de diabetes tipo 2.
? Estilos de vida
? Ex fumador desde hace 10 aos.
? Sedentarismo.
? Aspectos sociofamiliares y laborales
? Ferroviario jubilado.
? Tiene buen soporte familiar.
? Su creencia sobre la diabetes
? El paciente tiene recelo al tratamiento con insulina.
? ltimamente, a pesar de cuidarse ms que nunca, sin tomar azcar ni bollera, no tomar alcohol y anteriormente
habiendo dejado de fumar, las cifras de glucemia capilar en el autoanlisis son muy altas (200-250 mg/dl).
? Siempre ha escuchado de profesionales sanitarios que si no se cumple con el tratamiento prescrito (modificacin
tratamiento.
? Quedan en realizar un nuevo control a los 6 meses. Mientras tanto, tratar de intensificar el ejercicio y la dieta.
Que actitud teraputica sera la correcta para mejorar el control glucmico de este paciente?
Deberamos mantener el tratamiento con metformina y sulfonilurea al insulinizar?
Qu tipo de insulina utilizaramos (humana/anlogos; NPH/accin lenta) y cundo la administraramos?
Qu dosis de comienzo pautaramos y cmo realizaramos el ajuste de dosis?
Qu frecuencia de autoanlisis nos planteamos y qu contenidos mnimos de educacin diabetolgica debemos
ofrecer al paciente?
Bibliografa relacionada
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