Established diabetic on metformin
Give: ACE inhibitor (lisinopril) + Statin (atorvastatin); BP goal <130/80
Microalbuminuria → ACE inhibitor (nephroprotection)
Screen annually: dilated eye exam, foot exam, urine microalbumin
Order set
- HbA1c, lipids
- Urine ACR
- U&E
- Retinal + foot exam
- BP
Criteria
AdmitComplication (foot sepsis, AKI, ACS)
DischargeTargets set, screening arranged
Never
- Combine ACE inhibitor with ARB (no added benefit)
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Rising ACR
- Foot ulcer
- Rapid eGFR decline
Common mistakes
- Combining ACEi+ARB
- Neglecting foot/eye screening
Disposition & follow-up
BP <130/80, statin, ACEi for albuminuria; annual screening.
Discharge package
MedicationsACEi for albuminuria, statin, BP control; SGLT2i for CKD with ACR ≥30 or HF; finerenone for T2D + CKD (albuminuria despite ACEi/ARB, eGFR ≥25) — ADA 2026/KDIGO 2024
Follow-upAnnual eye/foot/renal screening
VaccinationInfluenza, pneumococcal
LifestyleGlycaemic + BP + lipid targets, foot care
Warning symptomsFoot ulcer, vision change, chest pain
💊 Treatment detail — doses & preparation
LisinoprilACE inhibitor
DoseStart 2.5–5 mg OD, target 20–40 mg OD
Preparation2.5/5/10/20 mg tablets
MonitorCreatinine + K⁺ 1–2 wk after each titration
Atorvastatinstatin
Dose20–80 mg OD (post-ACS 80 mg)
Preparation10/20/40/80 mg tablets, any time of day
MonitorLFTs baseline, muscle symptoms; target LDL reduction ≥50%
DapagliflozinSGLT2 inhibitor
Dose10 mg OD (HF ± diabetes)
Preparation10 mg tablets
MonitorSick-day rules (hold when fasting/surgery), euglycaemic DKA, genital infections, eGFR
📖 ADA / KDIGO Diabetes & CKDReviewed July 2026