5 Responses

  1. tmana
    tmana December 12, 2012 at 5:46 am | | Reply

    Losartan isn’t an ACE inhibitor; it’s an ARB-II blocker. (I should know — I’ve been on and off the stuff for a decade.) Many PCPs don’t suggest SMBG because of perceived insurance and economic issues, or because they don’t believe it does anything.

    Increasing losartan from 25mg to 50mg shouldn’t be a big deal, but I’d also make sure he’s testing and logging his BP at home (one monitor a year is included in most plans’ DME coverage).

    Given the family history of heart attack, some sort of diagnostic imaging would not be completely out of the question, especially to get a baseline. Whether a stress test is better than an echocardiogram is another story. (The stress test would need to be done with contrast for that, kicking up the cost of the test.) That said, an in-office EKG might have been the least expensive initial diagnostic tool.

    I notice you didn’t remark about his cholesterol levels. Did the program not give you that option?

    Also, a patient who eats “whatever his wife makes for him” suggests a need for family counseling where the wife is instructed what sort of diet her husband needs, and given resources to provide him the appropriate foods. Unfortunately, current diabetes care does not provide for that level of family counseling. (Additionally, there could be issues if her parents or their children object to dietary changes, or if there isn’t enough money to pay for them — although if he is an accountant, the money *should* be there…)

  2. Eileen
    Eileen December 12, 2012 at 8:17 am | | Reply

    Maybe there’s a good clue to this guy’s best treatment: He eats “whatever my wife makes.” Perhaps having his wife accompany Jorge to a diabetes education class might make a big improvement in his diet and exercise. (Or cause a divorce!)

  3. Paul Patten
    Paul Patten December 12, 2012 at 1:02 pm | | Reply

    I notice that all the patients seem to be type 2. Does this software have the ability to simulate a senior type 1 50 yr medalist. Would most doctors as well as the simulator’s designers assume that any diabetic over 50 is automatically type 2? Incidentally, both lisinopril and losartin cause coughing as well as other side effects in this long-time type 1; so, the losartin should be watched too.

  4. dargirl
    dargirl December 13, 2012 at 11:40 am | | Reply

    Sounds like an interesting tool. But as a patient, I already have issues with my Dr. not moving his head away from the computer after his first quesion? What brings you here today? I want eye contact. Not the hold the mouse, right click, text messaging postion. I appreciate a one on one conversation. They are professionals that deal with people not technology.

  5. Grivin
    Grivin December 13, 2012 at 12:01 pm | | Reply

    Thanks WilD , Your post is awesome and sounds great. Having diabetes has forced me to learn about diet and nutrition. I have also learned more about my physiology than I ever would have without the diagnosis. I am more aware of how I am feeling at all times.

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