Diabetes Mellitus:  Lipids

 

Case History

Patient is a 68-year-old African American female.  It is 3am and she is admitted with congestive heart failure.  You note in your exhaustive H&P that she has had Type 2 diabetes for at least 8 years.  She has been taking glyburide 5 mg (2 tabs bid), metformin 1000 mg (1 tab bid) and rosiglitazone 8 mg (1 tab qd).  

Key Medical History

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Tobacco:  Patient smoked in the past

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Alcohol: Patient does not drink

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Family History:
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6 siblings.  4 have been diagnosed with diabetes. 
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1 sister (age 71) died with DM and heart myocardial infarction. 

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1 sister alive takes insulin

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1 brother  - no information other than has DM

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1 brother who takes pills

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Patient has 2 daughters and 1 son.  She thinks a daughter may have had diabetes in pregnancy

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Eye exam:  did see optometrist for new glasses last year.  No mention of diabetes

Key Social History

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Patient lives alone. 

Key Physical Exam

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Blood Pressure:   173/94 (not orthostatic)

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Lungs:  Rales

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legs:  edema to thighs

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Foot exam:  Normal sensation (with 5.01 monofilament)

Key Lab Tests

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HgA1c 9.7  (found in computer system - clearly not back on admission labs)

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Creatinine 2.1

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AST, ALT:  both 30% over the upper limit of normal.