Chief Complaint J.T. is a 48-year-old male who presents to the primary care clinic with fatigue, weight loss, extreme thirst, and increased appetite. History of Present Illness J.T. was in his usual state of health until three weeks ago, when he began experiencing symptoms of fatigue, weight loss, and extreme thirst. He reports that he would like to begin a walking program, but he feels too fatigued to walk at any point during the day. Now he is very concerned about gaining more weight since he is eating more. He reports insomnia due to having to get up and urinate greater than 4 times per night.

 Chief Complaint

J.T. is a 48-year-old male who presents to the primary care clinic with fatigue, weight loss, extreme thirst, and increased appetite.

History of Present Illness

J.T. was in his usual state of health until three weeks ago, when he began experiencing symptoms of fatigue, weight loss, and extreme thirst. He reports that he would like to begin a walking program, but he feels too fatigued to walk at any point during the day. Now he is very concerned about gaining more weight since he is eating more. He reports insomnia due to having to get up and urinate greater than 4 times per night.

Past Medical History

Hypertension
Hyperlipidemia
Obesity
Family History

Both parents deceased
Brother: Type 2 diabetes
Social History

Denies smoking
Denies alcohol or recreational drug use
Landscaper
Allergies

No Known Drug Allergies
Medications

Lisinopril 20 mg once daily by mouth
Atorvastatin 20 mg once daily by mouth
Aspirin 81 mg once daily by mouth
Multivitamin once daily by mouth
Review of Systems

Constitutional: – fever, – chills, – weight loss.
Neurological: denies dizziness or disorientation
HEENT: Denies nasal congestion, rhinorrhea, or sore throat.
Chest: (-)Tachypnea. Denies cough.
Heart: Denies chest pain, chest pressure, or palpitations.
Lymph: Denies lymph node swelling.
General Physical Exam

Constitutional: Alert and oriented male in no acute distress
Vital Signs: BP-136/80, T-98.6 F, P-78, RR-20
Wt. 240 lbs., Ht. 5’8″, BMI 36.5
HEENT

Eyes: Pupils are equal, round, and reactive to light and accommodation, with normal conjunctiva.
Ears: Tympanic membranes intact.
Nose: Bilateral nasal turbinates without redness or swelling. Nares patent.
Mouth: Oropharynx clear. No mouth lesions. Teeth present and intact; Oral mucous membranes and lips dry.
Neck/Lymph Nodes

Neck supple without JVD.
No lymphadenopathy, masses, or carotid bruits.
Lungs

Bilateral breath sounds clear throughout lung fields. Breathing quality deep with fruity breath odor
Heart

S1 and S2 have regular rates and rhythms, tachycardia, and no rubs or murmurs.
Integumentary System

Skin warm and dry; Nail beds pink without clubbing.
Labs

Test Patient’s Result Reference
Glucose (fasting)

132

60-120 mg/dL

BUN

20

7-24 mg/dL

Creatinine

0.8

0.7-1.4 mg/dL

Sodium

141

135-145 mEq/L

Sodium

141

135-145 mEq/L

Chloride

97

95-105 mEq/L

HCO3

24

22-28 mEq/L

A1C

7.2

Urinalysis

Protein

Glucose

Ketones

Negative

Positive

Negative

Oral glucose tolerance test (OGTT)

220 mg/dL

J.T. is diagnosed with diabetes. Review all information provided in the case to answer the following questions.

Case Study Questions

Pathophysiology & Clinical Findings of the Disease

Review the lab findings and decide if the diagnosis is Type 2 or Type 1 Diabetes Mellitus.
Explain the pathophysiology associated with your chosen diagnosis
Identify at least three subjective findings from the case that support the chosen diagnosis.
Identify at least three objective findings from the case that support the chosen diagnosis.
Management of the Disease