Medicine Grand Rounds Clinical Vignette
Ayca Gucalp, M.D. September 27th 2006
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.
Physical Exam
General: healthy-appearing, welldeveloped 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
Laboratory Values
Corresponding HBA1c 7/05-8/06: 7.6 –> 8.8 BMP/CBC/LFTs/Spot UA Prot/Crt: WNL
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.
Diagnosis
Type I DM treated and well controlled with a continuous infusion insulin pump.