Diabetes in Clinical Practice: Questions and Answers from Case Studies. Verified Answers

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CASE STUDY 1 A 57 year old obese man (BMI: 32kg/m 2 ), hypertensive for ten years, with positive family history of Type 2 DM in his father, presents with a few months’ history of polyuria, polydipsi... a, polyphagia and easy fatiguability. A random blood sugar measurement reveals a level of 350mg/dl (19.4mmol/L) and HbA 1c 10.2 percent. What type of diabetes does this man have? CASE STUDY 2 A 14 year old thin man, without any significant past medical history and with no positive family history for DM, is transferred to the Emergency Department of the hospital in a comatose state. His breath is ketotic and his blood sugar level is 850mg/dl (47.2mmol/L). Diabetic ketoacidosis is diagnosed. His recent medical history reveals that he had lost about 8kg (17.6lb) during the last two months and had experienced polyuria, nocturia and intense thirst during the same time period. What type of DM does this patient have? CASE STUDY 3 A 47 year old man of normal weight (BMI: 22 kg/m 2 ), with no family history of DM, normotensive and with no other medical problems so far in his life, presents with symptoms compatible with diabetes (polyuria, polydipsia and slight weight loss), during the previous two months. A random blood sugar is 380 mg/dl (21.1 mmol/l), without ketosis. His HbA 1c is 9.5 percent. What type of DM does this patient have? CASE STUDY 4 A 48 year old woman comes to the of fi ce because she is worried she might be suffering from DM. The reason for her worries is that her father was diagnosed with Type 2 DM at the age of 55 years and died from an acute myocardial infarction at 74. Her cousin has also suffers from Type 2 DM (for ten years) and recently started treatment with insulin injections. A chemistry pro fi le a year ago showed a fasting plasma glucose level of 96 mg/dl (5.3 mmol/L). She has two children: the fi rst child was born 3.6 kg (7.9 lb) and the second 4.5 kg (9.9 lb). She does not report any diabetic symptoms. Her weight is 77.8 kg (171.5 lb) and her height 1.67 m (5 ft, 5.7 in). What will you recommend to the patient? CASE STUDY 5 A 70 year old man, diagnosed with Type 2 DM two months ago, comes to the office for a follow-up visit. His blood sugar levels are high, both fasting and after meals (250 – 350 mg/dl [13.9 – 19.4 mmol/L]). The patient was started initially on treatment with gliclazide (40 mg twice a day), which was gradually increased on a weekly basis. For the last 15 days, he has received the maximum dose of 320 mg/day. His weight is 68 kg (149.9 lb) and his height 1.78 m (5 ft, 10 in). The patient had not had a ketoacedotic coma at diagnosis, although before the diagnosis he had noticed significant weight loss accompanied by symptoms compatible with DM (polyuria, polydipsia), which continue despite nutritional treatment. There is no family history of DM. How will you treat this patient? CASE STUDY 6 A 54 year old woman comes to the clinic for evaluation of possible DM. She was referred by an ophthalmologist, because during fundoscopy for a glaucoma check-up, microaneurysms and haemorrhages were found in the retina. The patient is asymptomatic, without any signi fi cant medical history. Her mother had Type 2 DM, diagnosed at the age of 76. Can diabetic complications precede the clinical presentation and diagnosis of the disease? CASE STUDY 7 A 67 year old patient with Type 2 DM for six years, treated with sulfonylureas and metformin, comes to the clinic for a scheduled follow-up visit. His fasting blood sugar levels in the morning are 130 – 170 mg/dl (7.2 – 9.4 mmol/L), before lunch 130 – 150 mg/dl (7.2 – 8.3 mmol/L) and before dinner 120 – 160 mg/dl (6.7 – 8.9 mmol/L). His post-prandial levels (two hours after a meal) range between 140 – 200 mg/dl (7.8 – 11.1 mmol/L). His HbA 1c is 7.6 percent. Is his blood sugar control adequate? [Show More]

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