Short of breath
  Too tired
  The dwindles
  Weight loss
  Mom to be
  Very sociable
   Thanks To
 Mark W. Braun, MD

   Nutrition and Diagnosis-Related Care



Mrs. Lourdes Six-Killer is a 32 year-old Navajo Indian who has had poorly controlled diabetes (type 2) since the age of twelve. She is married with two children, a non-smoker and now complains of:
  • Lethargy, shortness of breath, loss of appetite, sense of bloating after eating and abrupt weight gain.
  • She has had declining renal function for 3 years.
  • Her diabetes has been treated, but not well controlled with oral Glucophage (metformin)
  • Physical exam:
    • Overweight Native American woman.
    • Vitals: 98.6oF, BP 212/96 mm Hg, P 86/min and regular, R 22 without labor.
    • Muscle weakness and 3+ pitting edema to the knee.
    • Auscultation of chest reveals bilateral rales and ronchi.
    • No abdominal tenderness and bowel sounds are present.
  • Take a look at her SGA form.

Lab values of significance:

Blood glucose = 312 mg/dL Blood urea nitrogen (BUN) = 74 mg/dL
Hemoglobin A1c = 9.1% Cholesterol = 274 mg/dL
Albumin = 3.1 gm/dL Triglycerides = 206 mg/dL
Sodium = 130 mEq/L Hemoglobin = 10.4 gm/dL
Creatinine = 8.5 mg/dL Hematocrit = 32%
Creatinine clearance = 16 ml/min Urine positive for glucose and protein
    Here's a quick calc for normals Reference range lab values

Let's get something straight about diabetes.

                                  Main Index | Slide Table of Contents | Case Studies Table of Contents