doc_clotaire
Forum Guru
Topics: 159
Posts: 1,245
|
A 40 year old man presents to your office with a 2 month history of polyuria, nocturia, polydipsia, polyphagia and a 30 pound weight loss despite having a "great" appetite. Eight hours prior he had drank a milkshake. A FSG in the office is 250 and a urine dipstick shows 4+ glucose only. His office visit height and weight were 5 foot 7 inches and 150 lbs. What would you do next:
- Admit him to the ICU for D.K.A.
- Have him record his FSG in a log and do an outpatient formal glucose-tolerance test
- Have him record his FSG and educate him on a diabetic diet
- Have him record his FSG, draw a HgbA1C and start him up on insulin
- Have him record his FSG and start up on an oral hyperglycemic controlling agent
___________________
The elevator to succes is broke ,you must take the stairs
|
| Doc750
transfer:step 3 prison
Topics: 52
Posts: 636
|
5
___________________
Experience is a hard teacher because she gives the test first, and the lesson afterwards.
|
| DrVirgo
Forum Hero
Topics: 1071
Posts: 3,409
|
Symptomatic patient with polyuria, polydipsia, ketonuria, and weight loss + a plasma Glucose of >200 = DM (no further testing needed).
5 Have him record his FSG and start up on an oral hyperglycemic controlling agent
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| Ivonne
Forum Guru
Topics: 55
Posts: 1,450
|
(5)
___________________
If you beleive you can do it then you WILL DO IT!! (by Mymeghhi)
|
| RitaM
Forum Newbie
Topics: 1
Posts: 61
|
I would go with option 5 .
|
| hanialkhadher
Forum Elite
Topics: 16
Posts: 256
|
C 
___________________
"أقرأ بأسم ربك الذي خلق,خلق الأنسان من علق,أقرأ و ربك الأكرم, الذي علم بالقلم,علم الأنسان ما لم يعلم"
|
| me007
Forum Guru
Topics: 72
Posts: 803
|
4? DM1?
|
| titly
Forum Elite
Topics: 18
Posts: 292
|
5. Have him record his FSG and start up on an oral hyperglycemic controlling agent
___________________
we spend our days waiting for the ideal path to appear in front of us, but, what we forget is paths are made by walking, not by waiting. keep walking................................
|
| doc_clotaire
Forum Guru
Topics: 159
Posts: 1,245
|
answer is : 4
As to the initiation of therapy, one has different options but acutely this man is insulin deficient. He has lost 30 pounds and would stand to benefit acutely with insulin to get him euglycemic quickly. Once he is feeling better and has acheived symptom control you could consider switching him to an oral agent.
___________________
The elevator to succes is broke ,you must take the stairs
|
| DrVirgo
Forum Hero
Topics: 1071
Posts: 3,409
|
This is deceptive because "start him up on insulin" sound like he has been diagnosed with DM-I and needs Insulin as a chronic long term medication... 
doc_clotaire wrote:
answer is : 4
As to the initiation of therapy, one has different options but acutely this man is insulin deficient. He has lost 30 pounds and would stand to benefit acutely with insulin to get him euglycemic quickly. Once he is feeling better and has acheived symptom control you could consider switching him to an oral agent.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| doc_clotaire
Forum Guru
Topics: 159
Posts: 1,245
|
You just have to stabalize him first and give him any oral med you want . Nowadays , they want you to be more agressive on the initial treatment of DM
___________________
The elevator to succes is broke ,you must take the stairs
|
| me007
Forum Guru
Topics: 72
Posts: 803
|
DrVirgo wrote:This is deceptive because "start him up on insulin" sound like he has been diagnosed with DM-I and needs Insulin as a chronic long term medication...
What tells you that it is not DM1, and what is pros for DM-2?
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
Con: Age?
|
| me007
Forum Guru
Topics: 72
Posts: 803
|
doyoudig wrote:
Con: Age?
DM1 oncet typically before 20 y.o. but can occur at any age.
|
| neuroblastoma
Forum Guru
Topics: 99
Posts: 1,016
|
Most people affected by type 1 diabetes are otherwise healthy and of a healthy weight when onset occurs, but they can lose weight quickly and dangerously, if not diagnosed in a relatively short amount of time.
|
|
| |
| | | | | | | | | | | | | | | |
