Question

A 70-year-old man with type 2 diabetes is admitted to the hospital with altered mental status and hypoglycemia. He had experienced recurring episodes of mild hypoglycemia over the previous week, which were managed with food. His past medical history includes chronic lymphocytic leukemia, gout, hypertension, and atrial fibrillation. Approximately 6 weeks ago, his serum creatinine increased from 1.6 mg/dL to 2.4 mg/dL following a bout of pneumonia. He had been taking glimepiride 4 mg twice daily. He admitted that he sometimes skipped the dose entirely because of hypoglycemia, and when he did so, his glucose was >200 mg/dL. His glycosylated hemoglobin (HbA1c) is 6.9%. Information and laboratory values collected at the hospital are as follows: Height, 5’9” Weight, 198 lb BMI, 28 BP, 114/73 mm Hg Current medications, glimepiride 4 mg BID and atorvastatin 10 mg QD HbA1c, 6.9% Lipids, LDL-C 45 mg/dL; HDL-C 55 mg/dL; Total-C 109 mg/dL; triglycerides 47 mg/dL Serum creatinine 1.94 mg/Dl

1. Which laboratory values are abnormal?

2. Which values are within normal limits?

3. What clinical manifestations correspond to the abnormal values?

4.What is likely the diagnosis of your patient? Explain your answer.

5.Are the pre-existing conditions of your patients causes some complications? Identify the complications and Explain your answer.

Answer 1

1) Hba1c - 6.9 is abnormal normal value is below six .

it indicates hemosylated glucose over a period of 3 months .
serum creatinine - normal level is 0.84 to 1.21 mg /dl here it is given 1.94mg/dl which is abnormal .
BMI - 28 ( 25- 29.9 ) is considered overweight

2) values within normal limit are -

ldl - 45mg /dl normal ( < 100mg /dl ) is normal

Hdl- 55mg/dl normal ( > 50mg/dl ) is normal

Total cholesterol- 109mg/dl normal ( < 200mg /dl ) normal

triglycerides- 47mg/dl ( < 150mg/dl ) normal

3) according to the abnormal value the patient is type 2 diabetic with raised serum creatinine going into kidney failure .

4) patient is type 2 diabetics and overweight , because his Hba1c is 6.9 which is abnormal and even serum creatinine is abnormal 1.94mg/dl.

5) complications the prexisting condition can cause are - with type 2 diabetic complications are - micro vascular - retinopathy, nephropathy , neuropathy

macrovascular - angina pectoris, transient ischemic attack , peripheral arterial disease .
The explanation of these complications are because the patients HbA1c is raised and also blood sugar is not maintained. Also with the raised creatinine level nephropathy is likely to occur .