Case Studies Answers
A N S W E R S
HM has multiple risk factors fordiabetes. Her risk factors include the following: age >45 years, body massindex >25 kg/m2, family
history of diabetes,African-American race, hypertension, and dyslipidemia (particularly if herhigh-density lipoprotein cholesterol
is <35 mg/dL or her triglyceridelevel is >250 mg/dL).
When mixing regular (or otherrapid-acting) insulin with NPH (or other longer-acting) insulin, the clearregular insulin should be
drawn into the syringe before thecloudy NPH insulin.
Unfortunately, DR cannot believe thepharmacist. First, the pharmacist exhibits the classic symptoms of opiate use,including pinpoint
pupils, drowsiness, and itching.Second, the amount of codeine and morphine found in poppy-seed bagels is notenough to
cause symptoms of intoxication.Third, morphine typically predominates over codeine when poppy seeds areingested. The pharmacist's
drug screen shows a predominance ofcodeine, as would be seen after codeine ingestion.