Clinical case studies on diabetes

Paauw, MD Presentation A year-old woman with a 3-year history of diabetes is seen for worsening dyspnea and cough.

Clinical case studies on diabetes

His diabetes is complicated by hypoglycemia unawareness. His last episode of hypoglycemia with loss of consciousness was at age He also has proliferative diabetic retinopathy treated with laser ingastroparesis treated with a low-fat diet and cisapride Propulsidand painful peripheral polyneuropathy.

He has had two cranial nerve palsies: He has also had bilateral carpal tunnel releases. There is no history of nephropathy, hypertension, dyslipidemia, tobacco abuse, or cardiovascular disease. Past medical history is remarkable for reflux esophagitis and a seizure disorder.

More recently, he was switched to insulin lispro.

Her initial laboratory studies included a blood glucose measurement of mg/dl, bicarbonate of 21 mmol/l (normal range 23–32 mmol/l), venous pH of , hemoglobin A1c (A1C) of %, and C-peptide of ng/ml (normal range – ng/ml). R.M. was admitted to the hospital for subcutaneous insulin therapy, fluids, and diabetes education. His diabetes is complicated by hypoglycemia unawareness. His last episode of hypoglycemia with loss of consciousness was at age He also has proliferative diabetic retinopathy treated with laser in , gastroparesis treated with a low-fat diet and cisapride (Propulsid), and painful peripheral polyneuropathy. Case Studies Managing the Patient With Type 2 Diabetes and Heart Failure Silvio E. Inzucchi, MD, offers his clinical perspectives in this case study exploring management and treatment of a patient with type 2 diabetes and multiple comorbidities, including heart failure, obesity, and coronary artery disease.

Other medications include cisapride 10 mg four times daily and famotidine Pepcid 20 mg twice daily. The patient is allergic to sulfa and penicillin. He does not use ethanol. In NovemberR. Two weeks earlier, he had been treated with azithromycin Zithromax for sinusitis.

He denied fevers, chills, hematochezia, and melana. Bowel sounds were present. Abdominal exam revealed a soft, flat abdomen with mild diffuse tenderness but no rebound or guarding. Stools for fecal leukocytes, ova and parasites, and c-difficile were all negative.

Because of dehydration, the patient required 2 liters of intravenous normal saline. He was treated symptomatically with Imodium and promethazine with gradual resolution of his symptoms.

Over the subsequent year and a half, the patient had seven similar episodes. During these episodes, he was afebrile but had vomiting and liquid bowel movements with mucus. The episodes generally lasted for 2 weeks and resolved.

Between episodes, he generally had one formed bowel movement per day but had alternating periods of constipation and diarrhea. He denied any problems with fecal incontinence. What is the differential diagnosis of vomiting and diarrhea?

What diagnostic testing should be performed? What is the best treatment strategy? In addition, his previous treatment with a broad-spectrum antibiotic for sinusitis raises the possibility of pseudomembranous colitis. Appropriate testing ruled out these possibilities and the recurrence of symptoms made these diagnoses less likely.

Nausea and vomiting in a patient with long-standing type 1 diabetes may represent gastroparesis, a manifestation of diabetic autonomic neuropathy. Diarrhea in a diabetic patient with gastroparesis raises the possibilities of both bacterial overgrowth and diabetic diarrhea.

Diabetic diarrhea is an uncommon but troubling manifestation of diabetic autonomic neuropathy. Diabetic diarrhea may be preceded by abdominal cramps.

It is often severe and watery but may occasionally be associated with steatorrhea.

Blood Glucose Monitoring

It is generally not associated with weight loss, but is often worse at night and may fluctuate from season to season. It is intermittent, and during remissions the individual may experience constipation, which characteristically lasts from a few hours to several weeks.

It may also be associated with fecal incontinence. Although gastroparesis, bacterial overgrowth, and diabetic diarrhea may occur in patients with diabetes, a thorough history, physical examination, and laboratory evaluation must be performed to rule out vomiting and diarrhea resulting from other causes.

Diabetic gastroparesis is a diagnosis of exclusion. The most important considerations in the differential diagnosis include acute or chronic metabolic disturbances, such as diabetic ketoacidosis or uremia, and gastric or intestinal obstruction.

The differential diagnosis of diarrhea includes medication-induced diarrhea, diarrhea associated with dietary sorbitol or lactose, enteric pathogens, pseudomembranous colitis, primary intestinal diseases, such as inflammatory bowel disease and celiac disease, and pancreatic exocrine insufficiency.

Clinical case studies on diabetes

CBC, electrolytes, blood urine nitrogen, creatinine, liver function studies, and thyroid-stimulating hormone were all within normal limits. Treatment with metaclopramide Reglan and domperidone did not prevent the episodes, nor did treatment with tetracycline mg 3 times per day for 14 days.His diabetes is complicated by hypoglycemia unawareness.

His last episode of hypoglycemia with loss of consciousness was at age He also has proliferative diabetic retinopathy treated with laser in , gastroparesis treated with a low-fat diet and cisapride (Propulsid), and painful peripheral polyneuropathy.

You may choose to review each patient with type 2 diabetes in any order. Select a case from the left by clicking the 'Click To Enter Case' link.

Her initial laboratory studies included a blood glucose measurement of mg/dl, bicarbonate of 21 mmol/l (normal range 23–32 mmol/l), venous pH of , hemoglobin A1c (A1C) of %, and C-peptide of ng/ml (normal range – ng/ml). R.M. was admitted to the hospital for subcutaneous insulin therapy, fluids, and diabetes education. Clinical trials are an important step in our being able to have new treatments for diabetes and other conditions. The American Diabetes Association is currently a partner providing support for the following clinical studies and initiatives. You may choose to review each patient with type 2 diabetes in any order. Select a case from the left by clicking the 'Click To Enter Case' link. Once you enter the case and before answering questions, click on the patient’s tab to view his clinical presentation, medical history, and current medications. Insulin pen use for type 2 diabetes.

Once you enter the case and before answering questions, click on the patient’s tab to view his clinical presentation, medical history, and current medications. Insulin pen use for type 2 diabetes. Her initial laboratory studies included a blood glucose measurement of mg/dl, bicarbonate of 21 mmol/l (normal range 23–32 mmol/l), venous pH of , hemoglobin A1c (A1C) of %, and C-peptide of ng/ml (normal range – ng/ml).

R.M. was admitted to the hospital for subcutaneous insulin therapy, fluids, and diabetes education. About this journal. Clinical Case Studies (CCS), peer-reviewed & published bi-monthly electronic only, is the only journal devoted entirely to case studies & presents cases involving individual, couples, & family heartoftexashop.com easy-to-follow case presentation format allows you to learn how interesting & challenging cases were assessed & .

Mail your case studies, along with a note stating your preference for the free book, to: Clinical Diabetes Case Studies, American Diabetes Association, Attn: Stacey Wages, N. Beauregard St., Alexandria, VA , or e-mail them to [email protected] Case Study: Abdominal Pain, Malaise, and a Bruise A year-old man presents to the hospital with generalized abdominal pain, malaise, subjective low-grade fever, and a bruise on his left shin.

My Site - Case Studies