Case
Rene has come in today for follow-up of his hyperglycemia. He has been using an OTC “magic pill” – taken po, qd that his co-worker gave him to use since about a week after his last visit (3 months ago). He has noticed a change in his symptoms – the polyuria and polydipsia have resolved. In the past two months, he has also noticed changes in his previously increased difficulties performing his ADLs – previously he had numbness and bilateral tingling of his lower extremities that he wasn’t sure the cause of.
He has a history of hypercholesterolemia and DM that were diagnosed earlier this year. His DOB is 11/19/1980 and his BMI is 36.9. He is concerned about his abdomen due to recent weight gain and he is worried about a “rash on his neck.” He thinks maybe he needs a biopsy since it might be “malignant melanoma,” which he has been reading about. His wife thinks he might be a hypochondriac but she is also worried that he has decided to take the “magic pill” instead of the antidiabetic he was prescribed. He has a glucometer and checks his sugar BID, post-prandial. He also describes occasional photophobia, was seen by an opthalmologist. His mother has diabetes, but she lives in the Philippines – he is unsure what her medications are but he thinks she might take insulin and everyone he knows that has taken insulin has problems with their kidneys and some have even had amputations
His physical exam was essentially normal, but significant for acanthosis nigricans, elevated blood pressure (this is the third visit with elevated blood pressure, indicating the presence of hypertension). He will have his labs ordered with the new diagnosis but also will have his A1C checked.
Discuss each of the bolded, italicized words as you discuss any aspect of this case you’d like to address as Rene’s PCP. And, always – have fun!
Questions
Advanced Pharmacology
1. What medications might you change or add today?
2. What are the main classes of medication for Rene’s conditions?
3. How might you start medications for Rene and over what period of time would you increase and why?
Advanced Pathophysiology
1. Be sure you understand each of the bolded, italicized words of this case.
2. As Rene’s PCP, select 5 bolded, italicized words (except antidiabetics, prescribed and acanthosis) and describe them in detail and their significance pathophysiologically.
