Some Docs Have To Work Harder Than Others...

The Medicare Carrier* for TX, CO, NM, OK and VA tightens the rules for medical decision-making

An established Medicare patient with poorly controlled diabetes and HTN seen in Dallas...

CC: HTN and diabetes

IINTERVAL HISTORY: The patient’s diabetes has gone completely haywire due to dietary non-compliance. HGBA1c is in the double digits. HTN is also poorly controlled despite a handful of different blood pressure medications from almost every class available.

EXAM: BP 180/80, HR 76, RR 22. NAD, conversant. NECK: FROM, no JVD or carotid bruits. LUNGS: CTA with normal respiratory effort. Heart: RRR, no MRGs, normal PMI in the MCL. There is trace bipedal edema. ABDOMEN: Soft, non-tender, no HSM. MUSCULOSKELETAL: Normal gait and station. No digital cyanosis.

Labs: HGBA1c 12.4, creatinine 0.7, HGB 14.4, spot prot/creat 99 mg/G.

IMPRESSION:

1. Poorly controlled Type 1 diabetes
2. Poorly controlled HTN

PLAN:

1. Add MINOXIDIL 5 mg PO BID.
2. Add DOXAZOSIN 4 mg PO QHS.
3. Increase 70/30 INSULIN to 60 units BID.
4. RTC in two weeks with the usual labs.

*TrailBlazer is the Medicare carrier for CO, NM, OK, TX and VA. Click HERE to go to their website.

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