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  #1  
Old 10-20-2011
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A 40-year-old African American patient of yours has been extremely worried about diabetes, as both his mother and father passed away from complication of diabetes. An overnight fasting blood glucose is 139 mg/dL. A repeat level 1 week later, also fasting, is 129 mg/dL. The patient initiates a diet and exercise routine that results in the loss of 9 pounds over 3 months. On repeat testing, however, his fasting blood glucose is 141 mg/dL. At this time, he denies any polyphagia, polydipsia, polyuria, or visual changes. The rest of his review of systems is likewise unremarkable. Past medical history is significant only for mild obesity and borderline hypertension. Vital signs and physical examination are normal. At this time, which of the following is an appropriate course of action?

A. Annual blood glucose monitoring
B. Begin NPH insulin twice a day
C. Increase diet and exercise goals
D. Oral glucose tolerance test
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Old 10-20-2011
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His 2 results are preetymuch diagnostic of DM so i dont think he needs any more testing specially as his 3rd test also came back high.

Since he is still obese and has HTN i would furthur work on his diet and excersize plan to try to control his DM and if that doesnt work then go for oral hypoglycemics ( NPH insulin would not be an initial tx choice in type 2 diabetes which this probably is if it was type 1 then i would go it)
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Old 10-20-2011
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C. diet and exercise ...
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Old 10-20-2011
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oral glucose tolerence test??????????????
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Old 10-20-2011
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Quote:
Originally Posted by mazrodin View Post
oral glucose tolerence test??????????????
D. Oral glucose tolerance test
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Old 10-20-2011
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The correct answer is E. This patient meets diagnostic criteria for diabetes, as he has persistently elevated blood glucose levels. There are three agreed upon criteria for diagnosing diabetes mellitus type two. Meeting any one of the three constitutes a diagnosis of diabetes. They are: (1) fasting blood glucose of greater than 126 mg/dL on repeat tests, (2) abnormal oral glucose tolerance test, and (3) signs and symptoms of hyperglycemia with a blood glucose level greater than 200 mg/dL. An appropriate initial therapy, if diet and exercise fail to control blood glucose, is to start an oral medication. Metformin often is chosen as a first-line medication as it has the lowest risk for hypoglycemia, and, unlike many of the other agents, does not increase a patientís weight.
Annual blood glucose monitoring (choice A) is inappropriate. This patient has diabetes and needs frequent checks until glycemic control is achieved. Once achieved, hemoglobin A1C levels, which give an idea of the average glucose levels over the past 3 months, can be used to monitor glycemic control.
NPH insulin (choice B) is rarely used as a first-line agent. Insulin has the highest risk for hypoglycemia and often results in weight gain that reduces peripheral muscle tissue glucose sensitivity. Furthermore, patients often are not inclined to have daily injections if they can avoid them.
It is not reasonable to expect more results from diet and exercise (choice C) in this patient. Most results are seen in the first 5 to 10 pounds of weight loss, which has not helped this patient. Furthermore, the loss of 9 pounds is a significant achievement, and more than most people can reasonably expect to lose and keep off. After a 3-6-month period of diet and exercise, it is recommended that medication be started in addition to lifestyle modifications.
An oral glucose tolerance test (choice D) is not necessary, as this patient already meets diagnostic criteria for diabetes. The results of such a test will certainly be abnormal.
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