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).
January 2008
Chief Complaint: A 50-year-old white male with type 2 diabetes mellitus (DM) is being treated with Humulin® 70/30 (Eli Lilly and Company, Indianapolis, Indiana) 10 U BID and glucophage 500 mg TID. The patient decided to seek another endocrinologist’s opinion and was referred by his primary care provider.
History of Present Illness: The patient was diagnosed with type 2 DM 2½ years ago and was treated immediately with Humulin® 70/30 and metformin. He denies symptoms of polyuria and polydipsia but complains of being hungry at bedtime. He states he eats 3 meals a day and midmorning and bedtime snacks. The patient has attempted to modify his diet because of weight gain in the past 2 years. He denies symptoms of hypoglycemia. Self-monitoring of blood glucose (SMBG) is sporadic, but all blood glucose results are in the mid to high 200s.
Medical History: In addition to type 2 DM, the patient has a history of HIV with undetected viral load but is on no antiviral medications at this time. He has hypertension treated with ramipril 10 mg and dyslipidemia treated with atorvastatin 10 mg.
Social History: The patient is a lawyer and lives with his partner in New York City. He has a past smoking history (20 years, 1–2 packs per day), and he joined Alcoholics Anonymous® >2 years ago.
Physical Exam: The patient is overweight with a body mass index of 26 kg/m2; height is 72 in and weight is 194 lb. He is in no acute distress. Blood pressure is 110/72 mm Hg; remaining vital signs are within normal limits. His skin examination is negative for acanthosis nigricans or hirsutism. The patient’s chest and heart examination is within normal limits. His abdomen is soft and nontender, with normal bowel sounds in all 4 quadrants. There is no hepatosplenomegaly. Extremity examination reveals no edema with strong pedal pulses. No neurologic deficit is present. Patient is referred to ophthalmology for funduscopic examination.
Lab Results: The following are his lab results: glycosylated hemoglobin (A1C), 5.3%; fasting plasma glucose, 107 mg/dL; total cholesterol, 132 mg/dL; high-density lipoprotein cholesterol, 24 mg/dL; low-density lipoprotein cholesterol, 81 mg/dL; triglycerides, 81 mg/dL; blood urea nitrogen, 22 mg/dL; creatinine, 0.9 mg/dL; hemoglobin, 14.3 g/dL; hematocrit, 41.4%; mean corpuscular volume, 87 fl.
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