WEEK 4

DIABETES

Case Presentation

14 y.o. male patient who presents to the clinic with his father to establish care. Previously lived and followed with health care at Altru Clinic with another provider. Family moved to Iowa for about a year. Returned to area earlier this summer. History of ADHD – on stimulant therapy since 1st grade after psychological testing and with positive results. Denies any adverse effects to medication including chest pain, somnolence, sleeping/appetite problems, staring/daydreaming, withdrawal, anxiety, irritability, somatic complaints, emotional lability, dizziness, or tics. Requesting refill of medication prior to school starting. 

States had a sports physical in April prior to moving back to area. Planning to play football. Has been attempting to be more active and eating healthier. States traded his x-box for a fishing pole. Has been fishing and doing trap shooting vs. TV and screen time. Has lost from 195 – 200 pounds down to 188 pounds this summer. Does note family history of thyroid disease in mother and several other extended family members. Grandparents and other family members with history of diabetes. Has had personal history of increased thirst – throughout the day and increased voiding – especially at night. States every couple of hours getting up to void. Usually drinks Powerade. Has not had glucose evaluated. Denies any other concerns.

On record states insomnia – denies any worsening symptoms – states actually “good” without treatment. Feels very tired by the end of the day and sleeping through the night.

History of headaches – but these have been very rare the last year.

Past Medical History

ADHD diagnosed in 1st grade.

Headache since age 5 yr.

Insomnia chronic

No Known Allergies

Review of Systems

Constitutional: negative for chills, fever. Active throughout the day. No napping. Regular sleep pattern. Still has some fatigue – feels dragging behind at times.

Ears, nose, mouth, throat, and face: No sore throat. No difficulty swallowing. 

Respiratory: Negative for wheezing or difficulty breathing. No cough.

Cardiovascular: Negative for chest pain and palpitations.

Gastrointestinal: Negative for change in bowel habits. Appetite stable. Denies abdominal pain, nausea, vomiting or diarrhea.

Genitourinary: As noted above. No hematuria.

Hematologic/lymphatic: negative for swollen lymph nodes.

Skin: No rash

OBJECTIVE:

BP 132/72 mmHg | Pulse 76 | Temp (Src) 99 °F (37.2 °C) | Resp 16 | Ht 5′ 4.5″ (1.638 m) | Wt 188 lb (85.276 kg) | BMI 31.78 kg/m2

Alert, cooperative, in no acute distress, appears stated age. Mild overweight. Head is normocephalic. No visible trauma. Tympanic membranes normal, cone of light and bony landmarks present bilaterally. Nasal mucosa patent. No drainage or congestion. Pharynx normal, tonsils not enlarged, no exudate, no oral lesions. No cervical adenopathy or thyromegaly. Lungs clear to auscultation. Heart has a regular rate and rhythm, normal S1, S2 without murmur. Abdomen is soft without tenderness, masses or organomegaly. Extremities have no edema. Skin warm and dry without rash.

 

Glucose Random testing

Glucose 396 (Range 70-99).

Questions:

1. What is your suspected diagnosis?

2. What additional questions or labs would you advise and why or why not? Include discussion of obtaining a C-Peptide level and lipid profile.

  
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