C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had high blood
sugar and cholesterol levels three years ago but did not follow up with a clinical diagnostic work-up. She
had participated in the state’s annual health screening program and noticed that her fasting blood sugar
was 141 and her cholesterol was 225. However, she felt “perfectly fine at the time” and could not afford
any more medications. Except for a number of “female infections,” she has felt fine until recently. Today,
she presents to the Indian Hospital general practitioner complaining that her left foot has been weak and
numb for nearly three weeks and that the foot is difficult to flex. She denies any other weakness or
numbness at this time. However, she reports that she has been very thirsty lately and gets up more often
at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more
water to keep hydrated. She has gained a total of 65 pounds since her last pregnancy 14 years ago, 15
pounds in the last 6 months alone.
- Clinical signs are objective manifestations of a disease that can be identified by someone other than the
patient. List a minimum of four signs from the case study above that support a diagnosis of type 2 diabetes
in this patient.
- Why do stress and infection promote hyperglycemia in patients with diabetes?
- Why should medications other than glipizide or glyburide be considered for management of diabetes in
this patient?
Sample Solution