Client presents for a routine follow-up appointment after starting pioglitazone two weeks ago.

He reports that his most recent blood glucose was 139 mg/dL (7.72 mmol/L) [70–110 mg/dL (4-6 mmol/L)].

The client states that the medication has caused persistent nausea, which improves when taken with food.

He also reports occasional heartburn after larger meals, which he manages by sitting upright after eating.

Additionally, the client notes the onset of ankle and foot swelling beginning five days ago.

On assessment, lung sounds are clear bilaterally; however, the client reports dyspnea with ambulation.

2+ pitting edema is observed in both ankles and feet.

Current weight is 255 lbs (115 kg), 6 lbs (2.7 kg) weight gain since the previous visit.

Vital Signs: BP 130/84, HR 82, RR 18, Temp 98.6°F (37°C), pulse oximetry 97% on room air.