Patient Case #1
CC: “My left foot feels weak and numb. I have a hard time pointing my toes up.”
HPI: C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had high blood sugar and cholesterol levels three years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed that her fasting blood sugar was 141 and her cholesterol was 225. However, she felt “perfectly fine at the time” and could not afford any more medications. Except for a number of “female infections,” she has felt fine until recently.
Today, she presents to the Indian Hospital general practitioner complaining that her left foot has been weak and numb for nearly three weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. However, she reports that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 65 pounds since her last pregnancy 14 years ago, 15 pounds in the last 6 months alone.
Vital signs: BP: 165/100mmHg P: 88/min, RR: 15/min, BT: 98.0F, HT: 5’3”, WT: 203lbs,
General: Significantly overweight Native American woman who appears slightly nervous, The patient is alert, oriented, and uses appropriate words, She does not appear to be acutely distressed and looks her stated age
Nek: Supple, no masses, JVD, lymphadenopathy, or thyromegaly, (+) bruit auscultated over right carotid artery
Chest and Lungs: CTA, no crackles or rales noted
Cardiac: RRR with no murmurs, rubs, or gallops, Normal S1 &S2, No S3 &S4
Rectal/Genitalia: (-) vaginal discharge, erythema, and lesions, Hemorrhoids, stool guaiac-negative
Laboratory Blood Test and Urinalysis Results
1. What is the significance of this patient’s cold feet and diminished peripheral pulses in the lower extremities?
2. Clinical signs are objective manifestations of a disease that can be identified by someone other than the patient. List a minimum of six signs from the case study above that support a diagnosis of type 2 diabetes in this patient.
3. List a minimum of five risk factors that predispose this patient to type 2 diabetes mellitus.
4. Which single urinalysis test result is more suggestive of type 2 than type 1 diabetes?
5. Which three blood chemistry test results strongly support a diagnosis of diabetes?
6. Why do stress and infection promote hyperglycemia in patient with diabetes?
7. Why should medications other than glipizide or glyburide be considered for management of diabetes in this patient?
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