CASE STUDY- TYPE 2 DIABETES INITIAL HISTORY • 52-year old black female. • Diagnosed with type 2 diabetes 6 years ago but did to follow up with recommendations for care. • Now complaining of weakness in her right foot and itching rash in her groin area. Question 1: What questions would you like to ask her about her symptoms? ADDITIONAL HISTORY • Patient says her foot has been weak for about a month and is difficult to dorsiflex; feels numb. • Denies any other weakness, numbness, difficulty speaking or walking, syncope, or seizures. She finds that watching television particularly in the evening, is becoming a problem because her eyes “are tired” more. • Has had some increased thirst and gets up more often at night to urinate, sometimes excessively. • Says she has a rash on and off for many years. It is worse when the weather is warm. It also occurs in her armpits. She gets some relief from salt baths. She occasionally gets a boil in these areas. • Denies any chest pain, shortness of breath, edema, change in bowel habits, or skin ulcers. Question 2: What other personal and family-related questions would you like to ask her about her diabetes? DIABETES HISTORY • Patient remembers being told her blood sugar was “around 200” when she was first diagnosed. She had gone for a work physical and felt fine at the time and saw no need for expensive drugs. • Her mother and sister have diabetes. Both of them were diagnosed in their 40’s and are on pills and injections. • Has been completely asymptomatic, except for rash, until the foot weakness. • Has gained 18 pounds over the past year and eats a diet high in fats and refined sugars. • Employed as banking executive and gets little exercise. Question 3: What would you like to ask about her about her medical history? PHYSICAL EXAMINATION • Obese female in no acute distress. • T= 37 C orally; P=80 and regular; RR=15 and unlabored; BP= 162/98 right arm (sitting); weight 84 kg. Skin • Erythematous moist rash in both inguinal areas, beneath both breasts, and in the axillae. • No petechiae or eccymoses. • Many dime-sized hyper pigmented spots located on the anterior shins HEENT, Neck • Pupils equal and round, fundi with mild arteriolar narrowing. • Nares and tympanic membranes clear. • Pharynx clear. • Neck without bruits or thyromegaly. Lungs, Cardiac • Lungs clear to auscultation and percussion. • Cardiac examination with distant heart tones, a regular rate and rhythm without murmurs or gallops. Abdomen, Extremities • Abdomen moderately obese with bowel sounds heard in all four quadrants; no abdominal bruits, tenderness, masses or organomegaly. • Extremities without edema; arterial pulses are diminished in volume but palpable in both feet. Neurologic • Alert and oriented. • Cranial nerves II through XII intact (including normal vision acuity with glasses). • Limb strength 5/5 throughout except 2/5 on dorsiflexion of the right foot. • Sensory perception to li.