UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Interactive diabetes case 17: A 57-year-old woman with newly discovered type 2 diabetes

Author
Lloyd Axelrod, MD
Section Editor
David M Nathan, MD
Deputy Editor
Jean E Mulder, MD

CASE

A 57-year-old woman was found to have hyperglycemia at a health fair when a random blood glucose level was 227 mg/dL (12.6 mmol/L). Several days later a fasting blood glucose value was 147 mg/dL (8.2 mmol/L). She has no previous history of diabetes, is alarmed by the possibility of having this disorder, and seeks your advice.

The patient has been treated for hypertension for 10 years, currently with amlodipine 10 mg by mouth daily. She was once told that her cholesterol value was “borderline high,” but does not know the value.

She denies symptoms of diabetes, chest pain, shortness of breath, heart disease, stroke, or circulatory problems of the lower extremities.

She estimates her current weight at 165 lbs (75 kg). She thinks she weighed 120 lbs (54 kg) at age 21 years, but gained weight with each of her three pregnancies and did not return to her non-pregnant weight after each delivery. She weighed 155 lbs one year ago but gained weight following retirement from her job as an elementary school teacher. No family medical history is available because she was adopted. She does not eat breakfast, has a modest lunch, and consumes most of her calories at supper and in the evening.

On examination, blood pressure is 140/85 supine and 140/90 upright with a regular heart rate of 76/minute. She weighs 169 lbs, with a body mass index (BMI) of 30.9 kg/m2. Fundoscopic examination reveals no evidence of retinopathy. Vibratory sensation is absent at the great toes, reduced at the medial malleoli and normal at the tibial tubercles. Light touch sensation is reduced in the feet but intact more proximally. Knee jerks are 2 + bilaterally but the ankle jerks are absent. The exam is otherwise within normal limits.

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Mar 10 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
Topic Outline