Diabetes Mellitus

Chapter 41 Diabetes Mellitus




Clinical Case Problem 1: An 18-Year-Old Woman with Weight Loss and Feeling Poorly


Jackie is an 18-year-old woman with no previous chronic medical problems who comes to your office with a chief complaint of “feeling rotten.” She tells you that she has lost 15 pounds in the past 2   months and has had increasing thirst and urination. The patient has been feeling fatigued and nauseous, which has gotten especially worse in the past 2   days after she “caught a cold” that had been going around her family members.


On examination, the patient is well below the 5th percentile for weight. She looks thin and pale and seems a little sluggish, but she answers questions appropriately. Her nose is slightly congested, but otherwise her mucous membranes are dry. Her temperature is 99°F, blood pressure is 95/70   mm Hg, and pulse is 110 beats/minute. Respirations are deep at a rate of 30 breaths/minute, and her breath smells fruity. She has a few anterior cervical and axillary nodes, each measuring 1   cm. Lungs are clear to auscultation. Her abdomen is slightly tender. No other abnormalities are found.



Select the best answer to the following questions




She follows your advice and is subsequently seen in the emergency department. Laboratory data include serum glucose concentration of more than 600   mg/dL, ketones in the urine at 4+, and a serum sodium concentration of 128   mEq/L (mmol/L).



3. Initial treatment should include which of the following?







4. To minimize risk of cerebral edema, lowering of the blood glucose level should be done no faster than what rate per hour in a patient with severe hyperglycemia?







5. Principles regarding evaluation of possible triggers that worsen the underlying condition include which of the following?







6. All except which of the following are true regarding type 1 DM?







7. The Diabetes Control and Complications trial and other landmark trials clearly demonstrated which of the following?







8. True statements regarding macrovascular complications in type 1 or type 2 DM include all except which of the following?







9. Which of the following statements regarding diabetic ketoacidosis (DKA) management is (are) true?







10. Regarding fluid and electrolyte management in DKA, all except which of the following are true?








Clinical Case Problem 2: A 35-Year-Old Man Who Comes in for a Routine Periodic Health Examination


Mr. Couchpo is a 35-year-old man who comes to your office for a routine health examination. He works as a computer programmer, is recently married, and came in because, as he said, “I want to make sure i am healthy.” The following are other key elements of the history and physical:



A 3-day dietary diary for this patient is summarized as follows:



Use this diet diary to answer questions 12 through 17.



11. Correct statements about this symptom complex include all except which of the following?







12. Choose the best answer regarding this patient’s carbohydrate sources.







13. Choose the best answer regarding this patient’s calorie intake.







14. Choose the best answer regarding the fat sources.







15. Choose the best answer regarding the protein sources in his diet.







16. Choose the best answer regarding this patient’s vegetable and fruit intake.







17. Choose the best answer regarding how this patient might handle sweets and sugar intake.







18. Regarding this patient’s exercise habits, assuming he has been medically cleared and can safely exercise, what would be the best advice?







19. Which of the following statements regarding type 2 DM is false?







20. Choose the best answer regarding the endocannabinoid system.








Clinical Case Problem 3: A 45-Year-Old African American Woman with Type 2 DM Diagnosed 6 Months Ago


Mrs. Jones is a 45-year-old asymptomatic obese African American woman who comes to your office for the first time for follow-up of her DM. She has transferred to you from her primary care physician out of state and was diagnosed with type 2 DM 6   months ago. She states that her previous physician started her on glyburide 5   mg daily before breakfast, told her to “cut out sugar and heavy foods,” and advised her to try to walk for 20 minutes three times a week. She is taking no other prescription medications, but she does take over-the-counter ibuprofen, a few pills a day, for knee osteoarthritis. She also takes chromium picolinate 200 μg/day and α-lipoic acid 600   mg/day because she heard from a friend at church that it helps diabetes. He also gave her a 2000-calorie American Diabetes Association (ADA) diet leaflet to follow. She has run out of test strips, but the last time she checked her fasting blood glucose level 2   months ago, it was 160, which is approximately average for her. She brings the results of his office records and most recent laboratory test results from 6   months ago, which show the following:



Her examination is consistent with the history and laboratory findings.



21. Choose the best answer regarding Mrs. Jones’s overall health status.







22. Initial management at your first visit should include all except which of the following?







23. When Mrs. Jones returns for her next visit, her HbA1c level is 8.8%. What lifestyle changes would you suggest next?







24. Mrs. Jones does lose 10 pounds during several months of coaching, but her repeated HbA1c level is 7.5%. If you wanted to add a second medication to her glyburide, what would you choose?







25. Which of the following statements regarding type 2 DM is true?







26. Choose the best answer regarding the patient’s use of chromium for DM.







27. Choose the best answer regarding the patient’s use of α-lipoic acid.







28. What is the best way to manage Mrs. Jones’s hyperlipidemia?







29. Initial steps in helping Mrs. Jones manage her mild knee osteoarthritis include all except which of the following?





Stay updated, free articles. Join our Telegram channel

Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Diabetes Mellitus

Full access? Get Clinical Tree

Get Clinical Tree app for offline access