Dm

[gaba101]

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came across something interesting on my rotations today - how do you explain the following readings in a patient:

52 y/o M w/ a PMH of hypertriglyceridemia (previously 1000 down to 450 now with drugs - no PMH of familiar hyper-TG-emia, though), acute renal insufficiency, hypothyroidism, hypertension, (NO DM) and has always had FBG of 90s (last one was in June 08) suddenly test for a FBG of 185 (patient claims he was fasting for 12 hours just like he's always done for all the previous lab work-ups)??? I mean, I can see if the patient's BG was previously always bordering in the 120s then I might buy this FBG but 90s to 185 in 3 months????? Anyone else find this scenario fishy?? MD signed the report off as pt having T2DM...hmm??? I just think it's very unlikely to become clearly non-diabetic to full-blown diabetes (full-blown since usually 2 readings of greater than 126 or I believe it is 1 reading greater than 180?? I could be wrong)

 

[JerryPharmD]

Is there a med list? (I don't think this this seeking medical advice 😕)

 

[Old Timer]

Repeat the test.....

 

[ItsOverZyvox]

Repeat the test.....

And I was anticipating a brilliant clinical answer from you as I opened the thread only to read..."Repeat the test..." What a let down!

 

[ItsOverZyvox]

renal insufficiency can cause insulin resistance, increased hepatic glucose output and abnormal glucose metabolism in non DM patient. But we need more HX.

 

[SpirivaSunrise]

For giggles, what's the HbA1c?

 

[KARM12]

For giggles, what's the HbA1c?

Took my question....

We had a patient on rounds today with A1c= 11.2 --which was down from last time when it was 13.5

 

[janeno]

I would go with the second test...

 

[Old Timer]

And I was anticipating a brilliant clinical answer from you as I opened the thread only to read..."Repeat the test..." What a let down!

Without more information and more detailed history, I always look for the simplest and most logical solution. I guess it comes from years of diagnosing sick computers (my second life). By the way, it was a brilliant clinical answer based on the information provided.😛

 

[RxWildcat]

what about an OGTT?

 

[Megas]

Maybe not so fishy? Hx of hypothyroid common in diabetics (have seen citations of 10-30%), maybe 1 autoimmune dis. (hypothy.) manifested before second autoimmune dis. (DM).
Any recent intro of SGAs, glucocorticoids in med hx?

 

[Megas]

Nobody posted after me. Am I a thread killer? OMG, I'm a thread killer (and a double-poster)!

 

[gaba101]

No OGTT done or HbA1C done; I just recommended that they repeat the FBG 🙂

 

[patmcd]

A repeat FPG is certainly a good idea. T1DM can occur at any age, so that is a possible cause of the rapid onset albeit not very likely.