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Managing Editor, Diabetes in Control

Managing Editor, Diabetes in Control

Question #820

Test Your Knowledge

Mr. Hernandez is an overweight (BMI 30 kg/m2), 45-year old plumber of Hispanic heritage who arrives at your office for a first-time visit. He has not been to a physician during the last 7 years because he hasn’t always had health insurance and “doesn’t like going to the doctor.” However, he has been noticing lately that his vision seems a little blurry and he’s developed a red, itchy rash in his groin. He is a non-smoker and recalls being told a long time ago that he should eat a low salt diet, but he can’t remember why. On examination, his BP is 154/96 mm/Hg, and his pulse is 72, RR 22. His physical exam is notable for signs of a yeast infection in his groin. You order a CBC and A1C to be drawn that day before he leaves. You advise him how to treat his skin infection. When you receive the results of the chem 12 panel, it shows a random plasma glucose of 162 mg/dL and A1C 7.3%. You call Mr. Hernandez and ask him to return the next morning, before he has eaten, for additional labs. In this individual, you might order all the following labs EXCEPT...follow the link to select your answer!

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Question #818

(Continued from Question #816 and Question #817) Mrs. O’Doole is a 34-year-old of Irish descent. She works as a florist and is married with three children. She arrives at your clinic for her annual wellness exam. Her blood pressure is 130/84 mmHg, pulse 65, BMI 24 kg/m2 and her physical exam is notable for acne and mild hirsutism. Her only current medication is oral birth control pills. She recalls starting OCP, 15 years prior, due to irregular menses. Based upon her medical history and physical, you believe it would be prudent to screen Mrs. O’Doole for type 2 diabetes. You discuss your recommendations with her and she agrees be tested. The lab returns a fasting plasma glucose (FBG) of 112 mg/dL. You share these results with your patient and inform her that, while only mildly elevated, she has impaired fasting glucose. She was started on lifestyle modifications plus dietary modifications, and exercise for weight loss. At a follow-up appointment 6 months later, Mrs. O’Doole tells you, despite good intentions, she has not been able to adhere to any meaningful lifestyle changes; in fact she has gained 5 pounds. At this time her repeat fasting plasma glucose shows FPG 138 mg/dL. After discussing management options with her, you decide the best management would be: (follow the link to respond!)

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The kidneys play a big part in controlling blood pressure. In fact, many of the major hypertensive medications have the root of their actions located in the kidneys. Diuretics work there, ACE inhibitors work there, as do the ARB’s, Spironolactone, and Triamterene. Over the past 18-20 months we have been …

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There are times that patients think that, magically, they start doing things right and their diabetes improves. We have all seen the obese diabetes patient who has started losing weight and feels they are doing well, only to find out that the weight loss is coming from the failure of …

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