Ellen is a 44-year-old woman who works full time as an art teacher in a local high school. She also teaches art courses on the weekends at the local senior center. She visited her health care provider...

Ellen is a 44-year-old woman who works full time as an art teacher in a local high school. She also teaches art courses on the weekends at the local senior center. She visited her health care provider last week for her annual physical exam and to update her TB screening (PPD) for the coming school year. The office called her back this morning with her laboratory reports and requested that she make an appointment to return tomorrow to discuss the results. Her serum glucose level was elevated at 224 mg/dL and she will need further testing to rule out type 2 diabetes. Ellen has follow-up testing with the results of a fasting serum glucose level returning at 131 mg/dL and a 2-hour 75-g oral glucose test of 242 mg/dL. A diagnosis of new-onset type 2 diabetes is confirmed. Ellen expresses disbelief and tells you, the nurse, “I can’t believe it! I watch what I eat; I don’t eat a lot of sugar, cookies, or candy. I drink only diet soda. I don’t have any of the symptoms you hear about. And no one in my family has ever had diabetes.” A health history and the results of Ellen’s recent physical examination confirm overall good health. Her height is 167.6 cm (66 in.) and weight 79.5 kg (175 lb) with a BMI of 28.2 kg/m 2, placing her in the “overweight” category. Vital signs, physical exam, and all other laboratory work are within acceptable limits. Ellen admits that she has been thirstier lately, “But it’s summertime and I always drink more when it’s hot.” She has also been urinating more frequently but attributes that to her increased fluid intake. Ellen’s provider will start her on glyburide (Micronase) and metformin (Glucophage) and will recheck her serum glucose in 1 month. In the meantime, she is to begin capillary blood glucose testing before meals and at bedtime, and to bring her log to the next visit. She is given dietary instructions and you will be providing instruction on her medications.

1. Why are two oral antidiabetic drugs prescribed for Ellen?

2. What essential teaching does Ellen need about her glyburide (Micronase) and metformin (Glucophage)?

3. Ellen asks why she is not being started on insulin. Why is insulin not being used at this time?

4. Ellen tells you that she occasionally enjoys a glass of wine with her dinner and wants to know if this is allowed. How will you answer?