The Case Study section of Insulin concludes with questions about the case being presented. A summary of the responses we receive for each case study will appear in the next issue along with a new case study (and its accompanying questions).
Jan 2006 - Case Study
Chief Complaint: A 29-year-old Hispanic woman came to an endocrine clinic to request human neutral
protamine Hagedorn (NPH) and regular insulin, both of which had been stopped 2 weeks previously when her
supply ran out.
History of Present Illness: The patient was initially diagnosed with diabetes mellitus (DM) during her first pregnancy at age 19. She stated that she was treated with insulin until the birth of her baby; then she was briefly placed on oral antidiabetic agents. Because of poor glycemic control, she was advised to restart insulin therapy. She was given a twice-daily insulin regimen of 50 units of NPH and 25 units of regular insulin. She was treated with this regimen of insulin for 10 years until 2 weeks ago, when her supply of insulin ran out and she moved to another state where she did not have a doctor managing her care. No records are currently available to document her medical history and therapy, including insulin use.
Medical History: The patient denied any concurrent medical problems and the use of any other medications. She stated that she has gained ~30 pounds over the past 10 years.
Social History: Fluent in Spanish only, the patient is a homemaker who cares for her 3 children; she is not employed outside the home. She does not smoke tobacco nor drink alcohol.
Physical Exam: The patient is a moderately obese woman (weight: 169 pounds; height: 5 feet, 2 inches; body mass index: 31 kg/m2) in no acute distress. Her blood pressure was 115/70 mm Hg and her heart rate was 80 beats per minute and regular. She was alert, cheerful, and fully coherent throughout the exam. She reported symptoms of polydipsia and polyuria, including nocturia (3 times nightly). Otherwise, the review of systems and physical exam were unremarkable.
Lab Results: A fingerstick blood glucose test taken during this visit measured 285 mg/dL and a urine dipstick analysis showed 3+ ketones.
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