Diabetes
Patient Presentation:
J.A., a 27-year-old female patient presented with fatigue to the local ED. Upon history she reported weight loss over the last four months with exercise but is “getting thinner” to where it is concern for her family. She reports drinking at least a liter of water daily and has frequent urination every 2-3 hours. The patient has a past medical history of gestational diabetes that was controlled by diet and resolved after birth. Denies nausea and vomiting.
Differential Diagnosis:
Type 1 diabetes mellitus, type 2 diabetes mellitus, hyperthyroidism, anorexia
Diagnosis:
Several tests were preformed to ensure that the patient was not in immediate danger. A CMP was order along with a TSH and a CBC to check for underlying imbalances that could cause symptoms. Her thyroid was not palpable upon examination and there we no cervical lymph nodes present to suggest an underlying infection. Urinalysis was sent to laboratory as well. Patient was also started on NS 500 ml bolus @ 150ml/hr to begin to offset the signs of fatigue.
Labs results as follows:
H/H: 12.1/37
RBC: 4.6
MCV: 90
MCH: 28
Platelet: 250,000
Calcium: 9
Chloride: 96
Magnesium: 1.6
Phosphate: 2.6
Potassium: 3.7
Sodium: 137
TSH: 0.75
Glucose: 463
UA wnl
Treatment:
Pt was treated with a 10 units of regular insulin SQ. Her blood sugar dropped appropriately to 95 within 90 minutes. She was monitored for signs of hypoglycemia and the fluid bolus was completed. Patient referred to endocrinologist for follow-up.
Follow-up:
Patient followed up with endocrinologist who diagnosed her with type 2 diabetes and prescribed 25mg metformin PO once a day paired with diet modification. This treatment was non-effective in controlling blood glucose levels. Pt reports home blood sugars to be no less than 250. Patient was referred to another endocrinologist who diagnosed her with type 1 diabetes and prescribed insulin – this treatment has been successful in controlling J.A.’s blood glucose.