Question

P.A. is a 52-year old man who presented with a 2-week history of polyuria, polydipsia, polyphagia, weight loss, fatigue, and blurred vision. A random glucose test performed 1 day before presentation was 352 mg/dl. The patient denied any symptoms of numbness, tingling in hands or feet, dysuria, chest pain, cough or fevers. He had no prior history of diabetes and no family history of diabetes.

Admission non-fasting serum glucose 248 mg/dl (N=<180 mg/dl), HbA1c 9.6% (N=4-6.1%). Electrolytes, BUN and creatinine were normal. Physical examination revealed weight of 180 pounds, height 5'5.5" (IBW 140-145). The rest of the examination was unremarkable, i.e., no signs of retinopathy or neuropathy.

The patient was taught self-monitoring of blood glucose and begun on 5 mg glyburide once a day. He was instructed in diet (1800 cal ADA). Blood glucose levels ranged from 80 to 120 mg/dl within 2 weeks of starting glyburide, his symptoms disappeared and weight remained constant.

During the next two months, blood glucose levels decreased to 80 mg/dl, and glyburide was stopped. Patient did not return until one year later; fasting serum glucose was 190 mg/dl, and HbA1c 8%. He again had polyuria and nocturia. Weight was unchanged from time of presentation. The physician put him on 5 mg/day of glyburide. His blood sugar one month later remained at 180 mg/day. At this point, his physician decided to put him on insulin alone, 20 units/day at bedtime. Two weeks later, his fasting plasma glucose was 120 mg/dl.

1. What are the mechanisms of blurred vision which was part of his initial symptoms?  

2. Are there correlations between his abnormal blood chemistries and his other symptoms?  

3. Calculate his approximate daily caloric needs. The patient is an accountant, and his daily exercise is limited to walking two blocks walking to and from the parking lot and his office.  

4. Why did an 1,800 calorie a day diet fail to lower his body weight?  

5. Was insulin treatment at this time the only possible option?  

Answer 1

1.Diabetes can have long-term or short-term effects on the eyes.blurriness happens for a different reason. In a person with diabetes, fluid can move into and out of the eye due to high blood sugar levels. This can cause the lens of the eye to swell.Short-term blurriness, due to high or low blood sugar levels, is temporary and will resolve when blood sugar levels return to normal.

2.Electrolytes,blood Urea and Creatinine have significant connections in Diabetes.Healthy men with a low level of serum creatinine are nearly twice as likely to develop type 2 diabetes.As your kidneys fail, your blood urea nitrogen (BUN) levels will rise as well as the level of creatinine in your blood.

3.

Approximate caloric intake in diabetes can be caluclated by Weight in Kg* 24 = 81.6 kg*24=1958 calorie per day

4.The prescribed Daily Caloric intake is required for the patient,so the prescription was not intended for weight loss.

5.The drug therapy coulb be titrated gradually ,Starting with a single injection of insulin to control basal glycemia while continuing oral therapy is the simplest approach, and lends itself to stepwise addition of mealtime injections as needed to bring most patients to glycemic targets in a logical and practical way.