CLC is a 73 year old admitted to the medical ward during your shift for acute exacerbation of chronic obstructive pulmonary disease ("COPD"). Her past medical history is also significant for type II diabetes, hypertension, unstable angina, upper gastrointestinal ("GI") bleeding, and recurrent urinary tract infections

CLC's current diabetes medications include:

Metformin 500 mg PO BD

Linagliptin 5 mg PO QD

Insulin Isophane Injection 24 units before breakfast and 12 units before dinner

a) How would the managment for COPD exacerbation affect CLC's current disease control (4 marks)

b) You are able to obtain some lab data for this patient. Based on the information below, what is your recommendation to optimize her diabetes management?

Chemistry: Na 136 mmol/L, K 3.8 mmol/L, ALT 43 IU/L

eGFR: 45 ml/min; HbA1c: 8.2%

Capillary blood glucose range: 3.6 - 13.3 mmol/L

LDL-C: 2.7 mmol/L; HDL-C: 1.0 mmol/L

c) What are the pros and cons of using empagliflozin in CLC? (4 marks)

d) What anti-diabetic medications have demonstrated significant reductions in cardiovascular ("CV") events in type II diabetic patients? (3 marks)