Medicine Grand Rounds Clinical Vignette

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Medicine Grand Rounds Clinical Vignette

• Ayca Gucalp, M.D. September 27th 2006

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History

• CC 42 year old male with Type I diabetes
  presents with uncontrolled morning finger sticks
  
• HPI The patient was initially diagnosed in 1978
  at the age of 24 when he was hospitalized with
  diabetic ketoacidosis. Since then he has been on
  multiple diabetic regimens including most
  recently lantus daily/novolog before meals and
  levamir twice daily/novolog before meals. His
  blood sugars at home generally ranged in the
  100-500s with day time sugars being the most
  elevated in the high 300s. Furthermore, he
  regularly reported polydypsia/polyuria/polyphagia
  at clinic visits. He has not been hospitalized
  since his initial presentation. There is no
  family history of DM.

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Physical Exam

• General healthy-appearing, well-developed
  Caucasian male in no acute distress
• T 98.4 HR 80 BP 100/80 RR 14 Ht
  72 in Wt 179 lbs BMI 24.36

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Laboratory Values

• Corresponding HBA1c 7/05-8/06 7.6 gt 8.8
• BMP/CBC/LFTs/Spot UA Prot/Crt WNL

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Therapeutic Course

• In July of this year the patient was started on a
  continuous infusion insulin pump which allowed
  his endocrinologist to adjust his basal/pre-meal
  insulin requirements to a tenth of a decimal
  point.
• The patient was still expected to check his blood
  sugar before meals count the amount of
  carbohydrates he was ingesting.

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Diagnosis

• Type I DM treated and well controlled with a
  continuous infusion insulin pump.