56 Year old female comes to you with symptoms of increased thirst and polyuria. Her BMI was 34 & Family history suggests death of her father by cardiac complications. Her blood pressure is 125/85 mmHg.
Labs are as follow :
MedQx 1 : What is the possible primary mechanism behind the pathology presented in the case :
MedQx 2 : Patient describes that despite loosing some weight, she failed to maintain her glucose level. What is the most appropriate therapy for this patient based on the current findings ?
MedQx 3 : Patient Started on Metformin & Simvastatin. What is the primary mechanism of Metformin therapy ?
MedQx 4 : Based on the urine analysis, which pathology should you suspect in this patient ?
MedQx 5 : Which is the only Insulin Dependent GLUT Receptors found on Skeletal Muscles and adipose tissue ?
MedQx 6 : What is the side effect of the most common therapy in this patient ?
Click "Read More" to check out the answers :
MedAx 1,3,4,5,6 : B
MedAx 2 : E
1 : Increase in Insulin Resistance is the primary mechanism for DM II. Destruction of Cells (Amyloid Deposition) occurs at later stages.
2, 3 & 6 : Metformin is used as first line drug to control DM II especially in obese as in this case. It acts by inhibiting hepatic gluconeogenesis and increasing peripheral uptake of glucose. It is recommended because they do not cause hypoglycemia and weight gain unlike sulfonylureas. Most common side effect of this drug is Lactic Acidosis especially in patients with kidney damage ( because this will lead to drug accumulation) & thus Metformin is contraindicated in Renal Insufficiency.
4 : Only GLUT 4 is insulin dependend receptor out of these 5. GLUT 4 is present on Skeletal muscles and adispose tissue.
Diagnostic Criteria :
Diabetes is defined when one of the following criteria is met:
(1) a glucose level greater than or equal to 126 mg/dL after an overnight (or 8-hour) fast on two separate occasions
(2) a random glucose level greater than 200 mg/dL, or
(3) a hemoglobin A1c (Hb A1c) level of greater than or equal to 6.5% on two separate occasions.
If the patient has classic symptoms of diabetes, one test is sufficient to make the diagnosis. In an asymptomatic patient, it is best to repeat the test. An oral glucose tolerance test is commonly used in pregnant women; otherwise, it is rarely used because of poor reproducibility and patient compliance. With a glucose tolerance test, diabetes is diagnosed when serum glucose levels in the blood reach or exceed 200 mg/dL within 2 hours of receiving a 75-g oral dose of glucose.
Cases By : Chirag Navadia. Follow Dr. Navadia at @MedRx22 . Subscribe to our website to receive weekly high yield posts directly to your email.