Mr.Joseph:45-years-old man

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2014

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Mr.Joseph:45-years-old man

Treatment and management

Quit smoking

Follow the Mediterranean diet

Monitor or control blood glucose at home

Metformin - Reduce postprandial and fasting glucose levels. Decreases glucose production, decreases intestinal absorption of glucose , reduced plasma glucagon levels and improve insulin sensitivity by reducing endogenous insulin production

Follow a healthy lifestyle

Biguanides - Inhibit hepatic and renal gluconeogenesis

Lab investigations

Blood glucose and HbA1c test

High HbA1c

High postprandial plasma glucose

High fasting plasma glucose

Lipid profile

High LDL cholesterol

Low HDL cholesterol

High triglycerides

High total cholesterol

Physical examination

Diminished sensation on the dorsum of the foot on soft touch

Bilateral peripheral pulses of dorsalis pedis and posterior tibial artery are palpable

Dry skin over both legs

Small ulcer at 2nd interdigital cleft of the left foot

Obese (BMI : 32kg/m2)

Signs and symptoms

Craving for sweet food

Polyphagia

Polydipsia

Nocturia

Polyuria

Dry skin

Diagnosis

Diabetic ulcer

Peripheral neuropathy

Type 2 diabetes mellitus

Pathophysiology

Genetic predisposing constitutional factors

Insulin resistance

Beta cell dysregulation

Impaired glucose tolerance

Beta cell insufficiency