A patient has a total cholesterol of 246 mg/dl and an LDL ("bad cholesterol") of 153 mg/dl (our goal, in the absence of established heart disease, is to keep the LDL under 100 mg/dl in a diabetic).
You start her on a prescription medication to lower the cholesterol and a follow-up LDL is 102 mg/dl (not bad).
Three months later, upon reviewing her medications at check-in, she informs you that she decided to stop the cholesterol medication 6 weeks prior -- "I just don't want to take it" is her response. She denies significant "side effects" (it is a generic, so we do not consider cost to be a major issue). .
You schedule her to come in fasting at her next visit so that the cholesterol profile can be re-checked. You'd like to get an idea whether a "non-statin" therapy can be considered.
She is a "no show" for that appointment.
You reschedule the appointment.
She shows for this appointment, but notes "I forgot" when asked why she did not fast (she had been given written instructions to fast for 10 hours before this visit).
You ask her to come in fasting the next week ... or ... go to the lab or her choice.
She does not comply.
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