Question

W.C. is a 56 year-old white male. His history was remarkable in that he had weighed 230 pounds until 2.5-3 years before, when he voluntarily went on a rigid diet and lost 50 pounds over about 1 year. He has maintained his current weight of 180-190 pounds for the last 1.5 years. Six years ago he complained of numbness in his feet and poor healing of cuts and bruises. He was seen by a physician who noted high blood glucose levels and high blood pressure. He was treated with 5 mg glipizide twice a day. He had no family history of diabetes. He denied other symptoms of diabetes.

Physical examination showed blood pressure of 156/100 mmHg, weight 200 pounds, height 5'9" (IBW = 155-160 pounds). Fundi contained capillary aneurysms, hemorrhages, and exudates. Laboratory data showed plasma glucose 140 mg/dl, HbA1c 7.6% (normal <6.2%), serum cholesterol 172 mg/dl, and serum creatinine 0.8 mg/dl. Urinalysis was normal. A spot microalbuminuria/urine creatinine ratio indicated 10 mg/gm creatinine. (Normal, <30 mg albumin/gm creatinine.)

Questions

1. Can the initial appearance of retinal microangiopathy at its diagnosis be attributed to diabetes?  

2. What is the most important risk factor that should be treated first?  

3. Is treatment of glycemia adequate, or should additional hypoglycemic treatment be postulated?  

4. Is management of hypertension in diabetes different from that in non-diabetic patients?  

Answer 1

1. retinal micro angiopathy is occurs in diabetes patients..Microaneurysms are the earliest clinical sign of diabetic retinopathy. for type 1 DM patients it can see after 5 years.. but for type 2 DM it will be visble from beginning...

2. the most important risk factor that should be treated first is hypertension.. hypertension increased the risk of type 2 DM, that results in serious complications like heart attack and decreased kidney function or renal failure leads to dialysis..

3.no,, 5 mg glipizide twice a day is not enough for controlling blood sugar level..Antidiabetic combinations medicines are two or more classes of antidiabetic agents in one pill or dose. Just having one pill may improve compliance and better glycemic control.

4. yes,, hypertension id the factor acclerate DM in patients, thus by controlling hypertension decreases both macrovascular and microvascular complications. microvascular complications like retinopathy and nephropathy and CVD can control