Mrs. S is a 45-yr. old
woman who presents with a 2 month history of fatigue and excessive thirst. She
is a new patient to your practice, relevant history includes possible
borderline hypertension, obesity and two children whose birth weights exceeded
9 lbs. She is a 1-2 pack a day smoker and family history is significant for
premature CAD, hypertension and diabetes. Her exam is normal and BP is 135/82
mmHg. Fasting Glucose 138 mg/dl. Other results include a total cholesterol
215, HDL-C 31 mg/dl. j
A week later Mrs. S returns
and further fasting glucose is 167 mg/dl. Subsequent HbA1c is 7.1% (normal
range 3.6-6.4%). Mrs. S comes to the office to discuss her results. You would:
Tell
her that she has mild diabetes and recommend checking her glucose again in
6 months
Tell
her she has diabetes and refer her for diabetes education and nutritional
counseling.
Start
her on an oral hypoglycemic agent such as a sulphonylurea.
Refer
her to an endocrinologist.
Mrs.
S. fulfills the diagnostic criteria for the diagnosis of diabetes. Currently
her HbA1c is not markedly elevated and she is not symptomatic. However
diabetes is a serious disease and at this point some intervention is
appropriate. An individualized meal plan and negotiated exercise plan should
be discussed with the patient and ideally the patient would see a diabetes
educator and nutritionist. While Mrs. S. may need an oral hypoglycemic agent
in the future a trial of diet and exercise is most appropriate in this case.
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