Compiled Case Information

Mrs. D is a 50-year-old African American woman who is worried she has diabetes. Mrs. D has worried about having diabetes since her father died of complications from the disease. Over the last couple of weeks, she has been urinating more often and notes larger volumes than usual. She is aware that excess urination can be a symptom of diabetes, so she scheduled an appointment.
Mrs. D has no dysuria or hematuria. She takes no medications, drinks 1 cup of coffee per day, and uses alcohol rarely. She has been trying to lose weight and has been drinking more water in an attempt to reduce her appetite.On physical exam, she looks a bit tired. Vital signs are as follows: BP, 138/82 mm Hg; pulse, 96 bpm; RR, 16 breaths per minute. The remainder of the physical exam is normal. A random plasma glucose is 152 mg/dL.
Mrs. D’s random glucose is elevated but is not diagnostic of diabetes. She reports that when she reduces her fluid intake, she urinates less. You ask her to return for more testing:FPG, 120 mg/dLHgbA1c, 6.0%Urinalysis: negative for protein, glucose, and blood; no WBCs or bacteria; specific gravity, 1.015.
Mrs. D stops forcing herself to drink extra water, and her urination pattern returns to normal. She is very concerned about her elevated FPG and wants to know how to prevent progression to diabetes. Her BMI is 30 kg/m2, and her fasting lipid panel shows total cholesterol of 220 mg/dL; HDL, 38 mg/dL; triglycerides, 250 mg/dL; and low-density lipoprotein (LDL), 132 mg/dL.
You refer her to a dietician for dietary counseling and recommend that she walk 30 minutes per day 5 days a week. When she returns to see you 4 months later, she has lost 8 pounds. Her FPG is 112 mg/dL; total cholesterol 197 mg/dL, HDL, 42 mg/dL; triglycerides, 150 mg/dL; and LDL, 125 mg/dL.

SOAP Note

S: Ms. D is a 50y/o AA woman with CC of “urinating more often and larger volumes than usual.”
-worried about this Sx being related to having diabetes because the pt’s father passed away from DM complications.
-trying to lose weight, hence, drinks more water to try to curb appetite
-currently on no medications.- denies dysuria or hematuria.
-SHx: drink a daily cup of coffee, denies alcohol use

O: BP = 138/82mmHg, P = 96bpm, RR = 16 breaths per minutes, BMI = 30kg/m2
General: looks tired
PE: unremarkable
Fasting Plasma Glucose (FPG) = 120mg/dL
HgA1c = 60%
UA = negative protein, glucose, and blood level; no WBCs/bacteria; specific gravity, 1.015
Fasting lipid panel = total cholesterol of 220 mg/dL; HDL, 38 mg/dL; triglycerides, 250 mg/dL; and LDL = 132 mg/dL

A: 55y/o female with increased urination, concerned about DM due to FHx of DM; likely prediabetes, elevated lipid panel

P:-educate on reducing intake on sugary foods/drinks, decrease carbohydrates and fats, inform of healthier food alternatives
-offer dietitian counseling
-ask pt to decrease water intake to see if there is still increased urination
-monitor FPG, HbA1c, lipid panel-encourage exercise
-schedule F/U in 3 months

Signature: Melinda Chiu, Physician Assistant Student

Summary

Diabetes Mellitus has multiple factors and causes that contribute to the disease. Some of these may include: antibodies that attack islet cells, insulin, certain tyrosine phosphates, and glutamic acid decarboxylase; human leukocyte antigen (HLA) association; more prone due to ancestry (such as African Americans and Asians); pancreatic diseases; endocrine issues; medications, or infection; gestational DM.

Prediabetes is a possible differential diagnosis due to her positive family history, polyuria and frequency (which is >3 L urine/day). She has the risk factors due to her being in an ethnic that is high-risk (African American), falling in the age group (above 45 years old), increased BMI (above 25 kg/m2), low high-density lipoprotein (HDL, less than 35mg/dL), increased triglycerides (above 250 mg/dL), and prediabetic values (increased fasting glucose and elevated HbA1c). To help a patient with prediabetes, clinicians should try to delay the patient from becoming diabetic. It is suggested to counsel the patient on proper diet (decreasing sugar intake of drinks and foods and carbohydrates), exercise habits (150 minutes of weekly aerobic exercise), and to maintain the blood pressure under 140/90 mmHg. Also she should be encouraged to have some weight loss, because women with a BMI above 35 kg/m2 has a higher risk of DM.