Diabetes Case Handout

Open Handout

 


 

Part 1

 

You are seeing Mr. H, a 70 y/o male with a history of hypertension and hyperlipidemia and diet-controlled type 2 DM. He has recently moved here and is presenting for an initial visit.  He has no complaints.

Past Medical History

Hypertension for 12 years
Hyperlipidemia for 6 years
Type 2 DM for 2 years

Past Surgical History

Appendectomy in early 20’s
ORIF of right forearm fracture in early 30’s
Colonoscopy 5 years ago – normal

Social History

Married for 46 years, 2 children
Retired electrician

Family History

Hypertension, diabetes

Medications

Lisinopril, 20 mg a day
Simvastatin, 20 mg a day
Aspirin, 81 mg a day

Allergies: NKDA

Vital Signs

BP 148/89, P 72, R 18, T 36.8, 171 cm, 98 kg

Assignment

  1. What information do you need to obtain?
    1. Write a list of the questions you are going to ask
    2. Write a list of the physical exam components you will complete
    3. What lab studies do you want to order?

___________________________________________________________________________________

Part 2

 

Mr. H is feeling well, and has no particular complaints or concerns. His last eye exam was about two years ago, and everything was “OK.” He has never been told that he has any sort of kidney trouble, and he has had no trouble with his urination. He wears full dentures. He has had no chest pain, shortness of breath, orthopnea, or pedal edema. He has never had any TIA or stroke symptoms. He has no claudication symptoms. His feet don’t bother him, and he has never had any foot problems.  He has some trouble with erectile dysfunction. Other review of systems is non-contributory.

He smokes cigarettes, about ½ PPD , and has an occasional beer or glass of wine – maybe 3 or 4 a week. He watches his sugar intake, and tries to walk about 1 mile per day.

He had a flu vaccine this year, but isn’t sure if he has had a pneumovax, and he has not had a zoster vaccine.

He does not check his blood sugar or blood pressure at home.

Physical Exam

HEENT – Edentulous, with dentures, o/w normal
Chest – Normal
Cardiac – Normal, pulses 2+ throughout
Abd – Normal
Extremities – Nl
Neuro – Nl
Feet – No abnormalities, sensation intact to 10 gram monofilament

Lab

CMP – Normal, with Cr 0.9, except glucose of 174
Hemoglobin A1c – 8.2%
Lipids – TC 230, HDL 42, LDL 140, TG 180

Assignment

  1. What is your plan?
    1. List your recommendations for management
    2. Prioritize this list
  2. What are possible “disease-aging” interactions that might occur in a patient with diabetes?