Differential Dx for Diabetes

Adeline Mason, a 35 year old white female has an appointment today at your office. She was seen 6 months ago for her comprehensive exam. At that time, the PE was normal, but she was 20 pounds overweight. Her CBC, FBS, BUN, creatinine, LFTs, pap smear and mammogram were normal. You referred her to the dietician and asked her to start walking 3-4 times per week. She has not been following a diet or exercising. She has been otherwise healthy, and she takes no medications. She is in today because she does not feel well.

CC: “Urinating more over the last few weeks & fatigue for one month”

HPI: Mrs. Mason says that she has been getting up at least one time

per night to urinate for a couple of months, but in the last week has gotten up 2-3 times at night. She also c/o frequency during the day. She states that she feels tired, but her appetite is okay. She states that she sleeps 7-8 hours per night.

CHS: as per information above

PMH: Mild Obesity; no previous surgeries

SH: she is a secretary

PE: VS: 97.8-80-20-150/100 67” 170#

General: 35 y/o white female in NAD

HEENT: PERRLA; EOMs intact; no AV nicking or tortuous vessels on fundoscopic exam

Cardiac:RRR; no m/g/r

Lungs: CTA a/p; no increased work of breathing; no CVA tenderness

Abdomen: truncal obesity; BS x 4 Q; no tenderness; no organomegaly

Lab: 2 hour postprandial glucose is 344 mg/dl

Dip UA shows 3+ glucose; no RBCs; 1+ WBCs; no ketones

no nitrites

The next morning, Mrs. Mason returns to your office for a fasting glucose, which is 202 mg/dl; her BP is 160/94.
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