Clinical Diabetes 24:187-189, 2006
© American Diabetes Association ®, Inc., 2006
A Unique Case of Basal-Bolus Therapy
Jessica K. Devin, MD and
Michael J. Fowler, MD
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Presentation
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R.R. is a 60-year-old white man whom we were asked to evaluate for
perioperative glycemic control. We met on his postoperative day 2 after repair
of an abdominal aortoiliac aneurysm.
His medical history was significant for peripheral vascular disease status
post-left lower extremity revascularization. His hypertension was controlled
with metoprolol and amlodopine, and he took atorvastatin for mixed
hyperlipidemia. Preoperative evaluation included a left heart catherization,
which demonstrated singlevessel disease and a depressed ejection fraction. His
primary care physician had recently indicated that he may have
"borderline diabetes." The patient reported nocturia and
polydipsia. He had an allergy to sulfa drugs, although he did not know the
exact nature of the allergy.
His father passed away in his 70s during his second coronary artery bypass.
There was no immediate family history of diabetes. R.R. is now retired, having
previously worked as a plumber. He reported a remote though significant
history of tobacco use.
On physical exam, he was comfortably sitting up in his hospital bed. Pulse
was 95 bpm, blood pressure 120/80 mmHg, and temperature 100.1°F. His
weight was 81 kg, and his height was 1.8 m, yielding a BMI of 25
kg/m2. There were no xanthomas on the eyelids. His thyroid gland
was not enlarged. Lungs were clear, and cardiovascular exam revealed the
absence of jugular venous distension and a normal S1 and S2. There were no
murmurs or gallops. His abdomen was appropriately tender along the incision
site, which appeared to be healing well without any drainage and only minimal
erythema. His vascular exam revealed the absence of carotid bruits. Dosalis
pedis pulses were difficult to palpate on both right and left, although his
feet were warm. He had a dime-sized, dry, nonerythematous ulcer on his right
second toe. His neurological exam revealed intact ankle reflexes and . . . [Full Text of this Article]
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