HISTORY: The patient is a 45-year-old woman followed here for type II diabetes with hyperlipidemia and hypertension. Medication currently includes Glipizide ER 10 mg in the morning, metformin 1500 mg in the morning and 500 mg in the evening, Vytorin 10/10 mg once a day and lisinopril 20 mg per day. The patient previously took Actos, which was discontinued more than a year ago after excellent blood sugar control. The patient denies chest pain, shortness of breath, claudication, numbness, paresthesias, polyuria, polydipsia and hypoglycemic symptoms. She has continued Lipitor and will be changing to Vytorin in the next week or two. She has been extremely compliant with her medication with blood sugar readings about 150 to 200 in the morning and higher at 6 or 7 p.m. frequently near 300. Glucotrol XL dose was increased to 10 mg twice a day by the patient's family doctor less than a week ago with a fasting reading yesterday of 116 and a noon time reading today of 125.

PHYSICAL EXAMINATION: Weight is 202 pounds with a decrease of 12 more pounds. Blood pressure is 110/70 mm Hg.

LABORATORY DATA: Fasting glucose 190, hemoglobin A1c 10.4, creatinine 0.9, cholesterol 189, LDL 133, HDL 43, triglycerides 64 and microalbumin 1.6.

IMPRESSION:
1. Diabetes, under poor control, now on Glucotrol XL twice a day.
2. Hyperlipidemia, under poor control although the patient has been taking her medication without change and has continued to lose weight.

PLAN: Glucotrol XL will be continued at 10 mg twice a day as adjusted less than a week ago. Vytorin 10/10 mg will be started in the next week as noted. The patient will follow up in two months after fasting glucose, hemoglobin A1c, lipids, liver functions and TSH. The patient will call if readings are persistently elevated in which case a low dose of Actos will most likely be added.