Case presentations about diabetes can vary widely depending on the type of diabetes, the patient's demographics, and the clinical context. Here are some examples of different case presentations across various scenarios:
1. Type 1 Diabetes Mellitus (T1DM) - Pediatric Case
Patient: A 10-year-old boy
Chief Complaint: Increased thirst, frequent urination, and weight loss over the past month.
History of Present Illness: The patient has been experiencing extreme thirst, polyuria (urination 6-8 times a day), and has lost 5 kg in the past month. He reported irritability and fatigue.
Past Medical History: No previous medical issues.
Family History: Positive for autoimmune conditions.
Physical Exam: BMI in the 25th percentile, dry mucous membranes, and mild abdominal tenderness.
Laboratory Results: Elevated blood glucose (450 mg/dL), elevated HbA1c (12.5%), ketones in urine.
Diagnosis: Type 1 Diabetes Mellitus.
Treatment Plan: Initiate insulin therapy, diabetes education for the family, follow-up in 1 week.
2. Type 2 Diabetes Mellitus (T2DM) - Adult Case
Patient: A 55-year-old woman
Chief Complaint: Fatigue and blurred vision over the last three months.
History of Present Illness: She reports having increasing fatigue, difficulty focusing, and occasional headaches. She also notes an increase in appetite but feels she has not lost weight.
Past Medical History: Hypertension, hyperlipidemia.
Family History: Father had T2DM, mother had cardiovascular disease.
Physical Exam: Obese (BMI 32), BP 140/85 mmHg, thready pulse.
Laboratory Results: Blood glucose 190 mg/dL, HbA1c 8.2%.
Diagnosis: Type 2 Diabetes Mellitus.
Treatment Plan: Start metformin, dietary counseling, exercise recommendations, and follow-up in three months.
3. Gestational Diabetes - Pregnancy Case
Patient: A 28-year-old pregnant woman (G2P1)
Chief Complaint: Routine screening for diabetes in pregnancy at 24 weeks gestation.
History of Present Illness: The patient has had an uncomplicated pregnancy until now. She was informed about potential gestational diabetes during her last visit.
Screening Results: 1-hour glucose tolerance test (GTT) shows a value of 180 mg/dL.
Diagnosis: Gestational Diabetes Mellitus.
Treatment Plan: Dietary modifications, blood glucose monitoring, and scheduled follow-ups. Education on signs of hyperglycemia and potential impact on delivery.
4. Diabetes with Complications - Older Adult Case
Patient: A 68-year-old man
Chief Complaint: Numbness in hands and feet over the past year.
History of Present Illness: The patient reports tingling and numbness in his extremities, particularly worse at night. He also has issues with his balance.
Past Medical History: T2DM diagnosed 10 years ago, neuropathy, and osteoarthritis.
Family History: Non-contributory.
Physical Exam: Decreased sensation in both lower extremities, absent ankle reflexes.
Laboratory Results: HbA1c 9.5%, foot exam shows no ulcers.
Diagnosis: Diabetic Neuropathy.
Treatment Plan: Optimize diabetes management (consider intensification of therapy), foot care education, pain management strategies.
5. Diabetes and Cardiovascular Disease - Middle-aged Case
Patient: A 60-year-old man
Chief Complaint: Chest pain on exertion.
History of Present Illness: The patient has had worsening chest discomfort severely during physical activities for the past two months. He also reports occasional shortness of breath.
Past Medical History: T2DM, hypertension, hyperlipidemia, history of smoking.
Family History: Family history of heart disease.
Physical Exam: Elevated BP (150/90 mmHg), elevated BMI.
Laboratory Results: HbA1c 7.8%, cholesterol levels indicating dyslipidemia.
Diagnosis: Diabetes with ischemic heart disease.
Treatment Plan: Cardiology referral for further evaluation, optimization of antidiabetic therapy, lifestyle modifications, possible cardiac intervention pending results.
In each of these cases, the clinical presentation highlights different aspects of diabetes management, diagnostics, and complications, illustrating the complexity of the disease and its associated conditions.