Mr. Gerache is a 59 yo man with poorly controlled diabetes and asthma who presented with chest pain. He had intermittent chest pain with activity lasting 5 minutes, relieved with rest, as well as shortness of breath when climbing stairs. Cardiac catheterization showed LAD prox 40%, no LCX lesions, no RCA lesions, and R PDA mid 30% lesion. Beta blocker was started, cholesterol was checked (elevated triglycerides 308, total cholesterol 146, HDL 29), statin was started and aspirin was held because of the patient's stated allergy to aspirin (causing asthma type symptoms). He was started on low-dose lisinopril and no prior echo was considered as outpatient. Patient was continued on home regimen of NPH insulin but clearly needs better control of his sugars as outpatient. Hemoglobin A1c is 10.7 and he will need better control of his sugars as outpatient. He has had asthma as a child and no record of PFTs but should obtain as outpatient, with home inhalers continued. Mr. Gaulding currently has good renal function but needs to have his Cr checked after starting the lisinopril. The patient was advised to consider carefully his lifestyle, including diet and exercise plans, and to take medications including VENTOLIN NEBULIZER (ALBUTEROL NEBULIZER) 2.5 MG NEB Q4H PRN Shortness of Breath, ATENOLOL 12.5 MG PO QD Starting IN AM (8/7), NPH HUMULIN INSULIN (INSULIN NPH HUMAN) 60 UNITS QAM; 70 UNITS QPM SC 60 UNITS QAM 70 UNITS QPM, LISINOPRIL 5 MG PO QD, ZOCOR (SIMVASTATIN) 20 MG PO QHS, FLOVENT (FLUTICASONE PROPIONATE) 44 MCG INH BID, COMBIVENT (IPRATROPIUM AND ALBUTEROL SULFATE) 2 PUFF INH QID, and make an appointment with his primary care doctor, take his medications as instructed, and follow up with his cardiologist within 4-6 weeks. He was also placed on a House / Low chol/low sat. fat diet, ADA 2100 cals/dy diet, 2 gram Sodium diet. He was discharged with Full code status and disposition to Home.
Has the pt. ever been on nph insulin before
Patient was continued on home regimen of NPH insulin but clearly needs better control of his sugars as outpatient.