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7/25/2019 2 DMTAC Clinic Case
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015
DM MTAC TRAINING CASE PRESENTATION
Nurul Farhana Binti IsmailPegawai Farmasi U4
!"s#ital Si$
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DEMOGRAP!IC DATA
Name SHA
Age 34 years old
Gender Female
Race Malay
Weight 95 kg
Diagnosis DM%!TN%I!D%D&sli#i'emia
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AS! M"D#$A% H#S!&R'Dia(etes Mellit)s !y*e +
Retino*athy ,se-ere NDR. eye clinic hos*k)lim/ rotein)ria +4 hr )rinary *rotein 401g2day
Hy*ertension
#HD ith dilated cardiomyo*athy Angiogram on 3225
Dysli*idemia
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M"D#$A!#&N H#S!&R'
Medication Dose Fre6)ency
#ndication
S2$ Mi7tard +8 ) D DM
!0 Met:ormin 588 mg D DM
!0 iso*rolol +05 mg &D #HD2H!
!0 Fr)semide 48 mg &D #HD2H!
!0 Diltia;em 38 mg !DS #HD2H!
!0 Rami*ril +05 mg &D #HD2H!
!0 Ator-astatin 48 mg &N Dysli*idemia
!0 Ferro)s:)marate
488 mg &D Anemia
!0 co2Folate #2# &D 505 ,*oor adherence/
AS! M"D#$A% H#S!&R'
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S&$#A% H#S!&R'
No dr)g a()se
No smoking
Non?Alcoholic
DR@G A%%"RG' NDA
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H'S#$A% RAM"!"R2G%'$"M#$ $&N!R&%
Parameter N"rmal 4()(4 *+((,
,mmHg/ B38218 312C1 4211
FS ,mmol2%/ 404?08 0 05
+H ,mmol2%/ 404?108 ? ?
RS ,mmol2%/ B808 ? ?
H(Ac ,/ B05 ? 30
RS ,42925/ > 401 mmol2%
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%##D R&F#%"
Parameter N"rmal *-(4(, ,(-(, *,()(,
!0 $hl,mmol2%/
305?50C C04 0 50
!G% ,mmol2%/ B 0C +0C +0+ +04
%D% ,mmol2%/ B +0 409 4 30
HD% ,mmol2%/ E 0 03 081 809
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Signi./ant 0a1"rat"r& Fin'ingsRenal Pr".le
arameters Normal Range 5225 +52125
Na 3?45 mmol2% 35 3
305 405 mmol2% 505 40
S$r 5C 38 )mol2% 4 3C
$r$l 8 ?88 m%2min 9+ C
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Signi./ant 0a1"rat"r& Fin'ings
arameters Normal Range 5225 +52125
Al()min 35 5+ g2% 34 +9
!0ilir)(in B38 )mol2% 40C 80C
!0rotein ?1C g2% C3 C8
A% 3?4 )2% 1 83
A%! B3+ )2% 4 4
0i2er Fun/ti"n Test
h i l $
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harmace)tical $are#nter-ention
Issue Inter2enti"n Out/"meatient cannot stick torigid meal time0*atient )s)ally ski*meals
d)e to hectic li:e. th)s
notinecting ins)lin
S)ggest to change:rom
*remi7ed ins)lin to(asal
(ol)s ins)lin
$hange to S2c Actra*id8 @ !DS. S2c Gargine +4 @&N
I Glargine red)cesincidence o: hy*o
Nely startedActra*id
ins)lin and Glargine
ins)lin
$o)nselled on thedose and
:re6)ency o: ins)lin0
"nco)raged SMG
atient )nderstood
atient has less)nderstanding on
dia(eticdiet
$o)nselled ondia(etic diet.
em*hasi;e oncar(ohydrate
e7chage
atient )nderstood
atient has *oor $o)nselled on the atient )nderstood
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NH
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R"F"R"N$"S3 M"nami M et/3 0"ng a/ting insulin anal"gues 2s NP! insulin "r
te * 'ia1etes mellitus3 C"/hrane Data1ase S&st Re2iew3
*++)5)6)47)8*3 Peter Shar#lin et/3 im#r"2e' gl&/aemi/ /"ntr"l 1& swit/hing
r"m insulin NP! t" insulin Glargine6 a retr"s#e/ti2e stu'&3*++8
93 Stratt"n IM et/3 Ass"/iati"n " gl&/aemia with ma/r"2as/ularan' mi/r"2as/ular /"m#li/ati"ns " T*DM5 #r"s#e/ti2e"1ser2ati"nal stu'&3 BM: *+++3
43 MO! CPG Management " Te * Dia1etes Mellitus 4th
e'iti"n*++8