Case study ( 8300 views as of February 21, 2019 )
Steve, a 24-year-old man presents with frequent urination, thirst, fatigue, blurred vision and a weight loss of 18 pounds over the preceding 3 months. He claims he has been drinking a lot of sugar-containing soda drinks lately. There is no family history of diabetes.
On physical examination, he is very thin with decreased body fat and some muscle wasting. His blood sugar is elevated to 36 mmol/L, which is extremely high and likely indicates Type 1 diabetes. There is no anion gap (acidosis) documented with his electrolytes and creatinine (kidney function) are normal with urinary ketones being trace positive.
Steve needs medication to lower his blood glucose levels immediately. He needs to see an Endocrinologist who can make a proper diagnosis and decide whether he needs oral agents or insulin treatment. Steve should also see a Diabetic Nurse Educator to learn about diabetes, self-monitoring blood glucose levels, how to inject insulin properly if needed and the prevention and treatment of low blood sugars.
Steve would also benefit from seeing a dietitian to talk about dietary advice in the short term and achieving better blood glucose control in the long term. A pharmacist could help Steve choose an insulin pump if needed, and a blood glucose monitor for home use. A personal trainer or Athletic Therapist could help Steve start a manageable exercise routine.Author: Dr. Richard Bebb