Why should medications other than glipizide or glyburide be considered for management of diabetes in this patient?List four sighs of dehydration in this patient?What is the significance of xerosis and cracking of the feet in this patient? 262| PART 7- NEUROENDOCRINE DISORDERSCASE STUDY 54= DIABETES MELLITUS, TYPE 2 263HeartPacan• Regular rate and rhythm with no murmurs, gallops, or rubs• Apical impulse normal at 5th ICS at mid-clavicular line• Normal S, ands,• No S, S,caseLaboratory Blood Test Results (After Overnight Fast)AbdomenSee Patient Case Table 54.2• Soft, NT with prominent central obesity• (+) BS in all four quadrants• (-) organomegaly, distension, or masses• Faint abdominal bruit auscultatedPatient Case Table 54.2 Laboratory Blood Test Results9.8 mg/dl.3.3 mg/dL.1.9 mg/dL LDL19 IU/L TrigHbA,43 IU/L.139 meg/l. Ca4.0 meq/L PO,NaT. cholesterol246 mg/dl.KHDL28 mg/dL.168 mg/dLci102 meg L Mg22 meq/l. AST14 mg/dl. ALT0.9 mg/dl. Alk phosнсо,HCO,458 mgidl.BUN13 IUL8.2%CrIns290 uU/ml.Glu168 mg/dl. T. bilirubin1.0 mg/dl.BreastsNo masses, discoloration, discharge, or dimpling of skin or nipplesUrinalysisGenitalia/RectumSee Patient Case Table 54.3• (-) vaginal discharge, erythema, and lesions• (-) hemorrhoids• Good anal sphincter tone• Stool is guaiac-negativePatient Case Table 54.3 UrinalysisAppearance Pale yellow andclearBilirubinNegativeMicroalbuminuriaNegativeMusculoskeletal and Extremities5.8KetonesNegativeGlucosePositiveNegative formicrobes, red cells,and white cellsSG1.008ProteinNegative Microscopy• Normal ROM in upper extremities• Reduced ROM in knees• (-) edema or clubbing• Peripheral pulses diminished to 1+ in both feet• Feet are cold to touch and dry with cracking, but no ulceration observed• Strength 5/5 throughout except 2/5 in left footElectrocardiogramFindings consistent with early left ventricular hypertrophyPatieNeurologic• Alert and oriented x 3• Cranial nerves II-XII intact (including good visual acuity)• Sensory response to light touch, proprioception, and vibration subnormal in both feetwith abnormalities greater in the left foot• DTRS 2+ throughout• Gait normal except for left foot weaknessPaltediagnosis of dnPport a CASE STUDY 54▪ DIABETES MELLITUS, TYPE 2 259CASE STUDYPast Surgical History54C-section 14 years agoDIABETES MELLITUS, TYPE 2OB-GYN History• Menarche at age 12• Menopause, natural, at age 46%: despite problematic hot flashes, she has chosen not to ini-tiate HRT• First child at age 17, last child at age 34, G,P,A, all babies were healthy, 4th child weighed10 Ibs 6% oz at birth• Last Pap smear 4 years agoFamily History• Type 2 DM present in younger sister and maternal grandmother; both were diagnosedin their late 40s; maternal grandmother died from kidney failure while waiting for a kidneytransplant; sister is taking "pills and shots"• Father had emphysema• Two older siblings are alive and apparently well• All four children are healthyFor the Disease Summary for this case study,see the CD-ROM.PATIENT CASEPatient's Chief Complaints"My left foot feels weak and numb. I have a hard time pointing my toes up."Social History• Married 29 years with 4 children; husband is a migrant farm worker• Family of 5 lives in a 2-bedroom trailer• Patient works full-time as a seamstress in a small, family-owned business• Smokes 2 ppd (since age 14) and drinks 2 beers most evenings• Has "never used illegal drugs of any kind"• Rarely exercises and admits to trying various fad diets for weight loss but with littlesuccess; has given up trying to lose weight and now eats a diet rich in fats and refinedHistory of Present IllnessC.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe whohad high blood sugar and cholesterol levels three years ago but did not follow up with a clin-ical diagnostic work-up. She had participated in the state's annual health screening programand noticed that her fasting blood sugar was 141 and her cholesterol was 225. However, shefelt "perfectly fine at the time" and could not afford any more medications. Except for a num-ber of "female infections," she has felt fine until recently.Today,sugarspresents to the Indian Hospital general practitioner complaining that her leftfoot has been weak and numb for nearly three weeks and that the foot is difficult to flex. Shedenies any other weakness or numbness at this time. However, she reports that she has beenvery thirsty lately and gets up more often at night to urinate. She has attributed these symp-toms to the extremely warm weather and drinking more water to keep hydrated. She hasgained a total of 65 pounds since her last pregnancy 14 years ago, 15 pounds in the last6 months alone.Review of SystemsGeneralAdmits to recent onset of fatigueHEENTPast Medical History• Seasonal allergic rhinitis (since her early 20s)• Breast biopsy positive for fibroadenoma at age 30• Gestational diabetes with fourth child 14 years agoMorning sickness with all four pregnancies• HTN x 10 years• Moderate-to-severe osteoarthritis involving hands and knees x 4 years• Multiple yeast infections during the past 3 years that she has self-treated with OTC anti-fungal creams and salt baths• Occasional constipationHas awakened on several occasions with blurred vision and dizziness or lightheadednessupon standing; denies vertigo, head trauma, ear pain, ringing sensations in the ears, diffi-culty swallowing, and pain with swallowingCardiacDenies chest pain, palpitations, and difficulty breathing while lying downLungsDenies cough, shortness of breath, and wheezing258

Question

Why should medications other than glipizide or glyburide be considered for management of diabetes in this patient?List four sighs of dehydration in this patient?What is the significance of xerosis and cracking of the feet in this patient? 262| PART 7- NEUROENDOCRINE DISORDERSCASE STUDY 54= DIABETES MELLITUS, TYPE 2 263HeartPacan• Regular rate and rhythm with no murmurs, gallops, or rubs• Apical impulse normal at 5th ICS at mid-clavicular line• Normal S, ands,• No S, S,caseLaboratory Blood Test Results (After Overnight Fast)AbdomenSee Patient Case Table 54.2• Soft, NT with prominent central obesity• (+) BS in all four quadrants• (-) organomegaly, distension, or masses• Faint abdominal bruit auscultatedPatient Case Table 54.2 Laboratory Blood Test Results9.8 mg/dl.3.3 mg/dL.1.9 mg/dL LDL19 IU/L TrigHbA,43 IU/L.139 meg/l. Ca4.0 meq/L PO,NaT. cholesterol246 mg/dl.KHDL28 mg/dL.168 mg/dLci102 meg L Mg22 meq/l. AST14 mg/dl. ALT0.9 mg/dl. Alk phosнсо,HCO,458 mgidl.BUN13 IUL8.2%CrIns290 uU/ml.Glu168 mg/dl. T. bilirubin1.0 mg/dl.BreastsNo masses, discoloration, discharge, or dimpling of skin or nipplesUrinalysisGenitalia/RectumSee Patient Case Table 54.3• (-) vaginal discharge, erythema, and lesions• (-) hemorrhoids• Good anal sphincter tone• Stool is guaiac-negativePatient Case Table 54.3 UrinalysisAppearance Pale yellow andclearBilirubinNegativeMicroalbuminuriaNegativeMusculoskeletal and Extremities5.8KetonesNegativeGlucosePositiveNegative formicrobes, red cells,and white cellsSG1.008ProteinNegative Microscopy• Normal ROM in upper extremities• Reduced ROM in knees• (-) edema or clubbing• Peripheral pulses diminished to 1+ in both feet• Feet are cold to touch and dry with cracking, but no ulceration observed• Strength 5/5 throughout except 2/5 in left footElectrocardiogramFindings consistent with early left ventricular hypertrophyPatieNeurologic• Alert and oriented x 3• Cranial nerves II-XII intact (including good visual acuity)• Sensory response to light touch, proprioception, and vibration subnormal in both feetwith abnormalities greater in the left foot• DTRS 2+ throughout• Gait normal except for left foot weaknessPaltediagnosis of dnPport a CASE STUDY 54▪ DIABETES MELLITUS, TYPE 2 259CASE STUDYPast Surgical History54C-section 14 years agoDIABETES MELLITUS, TYPE 2OB-GYN History• Menarche at age 12• Menopause, natural, at age 46%: despite problematic hot flashes, she has chosen not to ini-tiate HRT• First child at age 17, last child at age 34, G,P,A, all babies were healthy, 4th child weighed10 Ibs 6% oz at birth• Last Pap smear 4 years agoFamily History• Type 2 DM present in younger sister and maternal grandmother; both were diagnosedin their late 40s; maternal grandmother died from kidney failure while waiting for a kidneytransplant; sister is taking &#34;pills and shots&#34;• Father had emphysema• Two older siblings are alive and apparently well• All four children are healthyFor the Disease Summary for this case study,see the CD-ROM.PATIENT CASEPatient's Chief Complaints&#34;My left foot feels weak and numb. I have a hard time pointing my toes up.&#34;Social History• Married 29 years with 4 children; husband is a migrant farm worker• Family of 5 lives in a 2-bedroom trailer• Patient works full-time as a seamstress in a small, family-owned business• Smokes 2 ppd (since age 14) and drinks 2 beers most evenings• Has &#34;never used illegal drugs of any kind&#34;• Rarely exercises and admits to trying various fad diets for weight loss but with littlesuccess; has given up trying to lose weight and now eats a diet rich in fats and refinedHistory of Present IllnessC.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe whohad high blood sugar and cholesterol levels three years ago but did not follow up with a clin-ical diagnostic work-up. She had participated in the state's annual health screening programand noticed that her fasting blood sugar was 141 and her cholesterol was 225. However, shefelt &#34;perfectly fine at the time&#34; and could not afford any more medications. Except for a num-ber of &#34;female infections,&#34; she has felt fine until recently.Today,sugarspresents to the Indian Hospital general practitioner complaining that her leftfoot has been weak and numb for nearly three weeks and that the foot is difficult to flex. Shedenies any other weakness or numbness at this time. However, she reports that she has beenvery thirsty lately and gets up more often at night to urinate. She has attributed these symp-toms to the extremely warm weather and drinking more water to keep hydrated. She hasgained a total of 65 pounds since her last pregnancy 14 years ago, 15 pounds in the last6 months alone.Review of SystemsGeneralAdmits to recent onset of fatigueHEENTPast Medical History• Seasonal allergic rhinitis (since her early 20s)• Breast biopsy positive for fibroadenoma at age 30• Gestational diabetes with fourth child 14 years agoMorning sickness with all four pregnancies• HTN x 10 years• Moderate-to-severe osteoarthritis involving hands and knees x 4 years• Multiple yeast infections during the past 3 years that she has self-treated with OTC anti-fungal creams and salt baths• Occasional constipationHas awakened on several occasions with blurred vision and dizziness or lightheadednessupon standing; denies vertigo, head trauma, ear pain, ringing sensations in the ears, diffi-culty swallowing, and pain with swallowingCardiacDenies chest pain, palpitations, and difficulty breathing while lying downLungsDenies cough, shortness of breath, and wheezing258

Accepted Answer

Diabetes problems such as nerve damage and eyesight loss can result from uncontrolled high blood…

Why should medications other than glipizide or glyburide be considered for management of diabetes in this patient? List four sighs of dehydration in this patient? What is the significance of xerosis and cracking of the feet in this patient?