Ms. Sanchez is a 57-year-old female with both type 2 diabetes and hypertension who presents as a new patient at a family medicine practice. She takes metformin and glipizide. She reports that she is tired and has urinary frequency and burning pains in her feet. Physical exam is remarkable for mild to moderate lower extremity neuropathy, elevated blood pressure, and a 15-pound weight gain in the past year. Ms. Sanchez’s elevated blood pressure, dyslipidemia, and cardiovascular risks are addressed with the addition of lisinopril, atorvastatin (Lipitor), and aspirin. Further evaluation confirms that her diabetes is poorly controlled (her glycosylated hemoglobin [HbA1C] is 9.5%) on maximal doses of two oral medications. Students learn how to introduce the need for insulin to the patient and review other pharmacologic options for treating type 2 diabetes. Students also attend a group diabetes visit with the patient and learn more about the role of the primary care physician in the multidisciplinary care of diabetes.
Differential diagnosis: Not applicable
Final diagnosis: Type 2 diabetes mellitus
Final Diagnosis: Diabetes mellitus – adultNeuropathy
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