Based on the below case study answer the following question:
What are you thoughts about his blood glucose levels and A1C in this initial scenario? The case notes that his fasting plasma glucose=209 mg/dl and his HgbA1C=9.1%. Would these labs values be diagnostic for diabetes mellitus type II?
If you had decided to diagnose John with diabetes mellitus type II, what would you prescribe to him for medication therapy?
Case Study & Discussion Questions
John is a 46-year-old male who presents for his yearly physical examination. He has no complaints. Previous medical history is notable for obesity and hyperlipidemia He reports a very sedentary lifestyle. He sits at a desk for 8 to 10 hours per day and when he comes home he “just wants to relax in front of the television.” He doesn’t feel motivated enough to exercise on a regular basis, although he knows he should.
John is allergic to penicillin (hives). Medications include atorvastatin 10mg daily and a multivitamin. He occasionally takes acetaminophen for a headache.
Family history is significant for diabetes (mother, maternal grandmother, paternal grandfather) and hypertension (father and brother). He is a nonsmoker and reports drinking “a few beers on the weekend during football season”. His diet largely consists of fast food meals. He drinks sweet tea with every meal and an additional 3-4 cups of coffee per day. Previous labs and exam last year are unremarkable.
Vitals today: BP 130/70 mm Hg, pulse 82 and regular, temperature 98.7, respirations 18, height 6’1”, weight 235 pounds (up 3 lbs. since his visit 1 year ago).
He completed fasting labs prior to this appointment as he was instructed which reveal the following:
Fasting plasma glucose=209 mg/dl, HgbA1C=9.1%, TSH=4.0mU/L and Free T4=1.1 ng/dl. Fasting lipid panel includes the following: total cholesterol=190 mg/dL, HDL=35 mg/dL,
