This entry is part of an ongoing series where pharmacists describe inspiring patient interventions. Have a story you wish to share? Send it to bruffell@ensembleiq.com.Today, I met a patient for the first time who in addition to Type 2 diabetes and hypertension has depressed renal function (eGFR 23ml/min), two cardiac stents and sensory and painful diabetic neuropathy.We discussed managing his diabetes with all of these risks (he sells insurance and says he appreciates reducing risks), and the relationship between all of his circulation issues and therapy targets for cholesterol, blood pressure and blood sugar.He is not on a statin, despite several reasons that he might benefit from being on one. On enquiry he revealed that he had experienced GI upset with rosuvastatin on two separate occasions a few years ago, but nothing else had ever been tried.We discussed different options and the evidence. He chose first to try a low dose of atorvastatin, recognizing the need for a 40% lowering of LDL to target and the possibility of dose increases down the road.We discussed alternative plans should tolerability still be an issue, and his tolerance of intolerability for a few weeks to determine if issues are long term.We addressed an untreated indication while considering potential problems from therapy and negotiated a care plan to put before his physician, and a recommendation has been sent.Ken Burns is pharmacist at the Diabetes Care Centre at Sudbury Regional Hospital.
