How do you help your patient, a 48-year-old Hispanic man with hypertension, hyperlipidemia, and newly diagnosed type 2 diabetes manage his diabetes and avoid hypoglycemia? This interactive case study features current definitions of hypoglycemia, hypoglycemia unawareness, and hypoglycemia-associated autonomic failure while explaining the implications of hypoglycemia on both short- and long-term outcomes of Type 2 diabetes mellitus.
A 52-year-old male presents with “brittle diabetes.” He was diagnosed three years ago with type 2 diabetes (T2DM). His A1C was 10.6% at that time. He was started on metformin and titrated up to 500 mg at breakfast and lunch and 1,000 mg at dinner. The patient is 6’0” and 161 lbs. with a BMI 21.8; BP of 128/82, and pulse of 69. Blood tests show his current A1C as 8.7%, triglycerides as 131 mg/dl, HDL as 53 mg/dl, and LDL as 97 mg/dl. Is T2DM the correct diagnosis for this patient?
Last week I had a 47-year-old patient with diabetes ask whether he should take aspirin in order to prevent heart disease. He has had good glycemic control and an A1C around 6.5% since his diagnosis 5 years ago, which occurred shortly after he stopped smoking.
Due to conflicting guidelines, answering this question about aspirin therapy used to be easier than it is now.
A 58-year-old Caucasian female presents to your office for a recheck. She has had type 2 diabetes mellitus (T2DM) for 16 years and has a history of hypertension, dyslipidemia, and obesity, with minimal diabetic retinopathy and albuminuria...
A 38-year-old Caucasian male presents to your office reporting symptoms of fatigue, thirst, and weight loss. He has not been to a physician since his late 20s. Your physical examination shows high blood pressure (150/96 mmHg) and a BMI (body-mass index) of 36 kg/m2. There is a family history of cardiovascular disease, although the patient himself reports having no personal history of cardiac symptoms or cardiovascular events.
- A 25-year-old graduate student originally presented to you with symptoms of a UTI. An urinanalysis showed signs of infection, as well as glycosuria.
A 52-year-old Caucasian man was diagnosed with type 2 diabetes (T2DM) eight years ago and has been under your care for the past three years. His current treatment regimen includes glargine (50 units daily), metformin (1,000 mg b.i.d.), and glimepiride (2 mg daily), as well as lisinoprol (20 mg daily), and atorvastatin (20 mg daily).
Recent blood tests came back normal for lipid levels as well as renal and liver function, but showed an HbA1c level of 8.0%.
A 55-year old Caucasian woman has been under your care for three years. Eighteen months ago you diagnosed her with type 2 diabetes mellitus (T2DM). She has a history of mild hypertension, hypercholesteremia, and retinopathy.
A 45-year-old African American man with a history of obesity and hypercholesteremia has been under your care for the past three years. He has a family history of both T2DM (type 2 diabetes mellitus) and cardiovascular disease but no history of cardiovascular events.
A 63-year-old Hispanic woman with type 2 diabetes (T2DM) has been under your care for ten years and she was diagnosed with T2DM six years ago. In addition to long-standing hypertension and hypercholesteremia, she has a BMI (body-mass index) of 31 kg/m2 as well as a family history of cardiovascular disease.
However, she has never had a cardiovascular event and does not report any cardiac symptoms.