1
Maria is a 46-year-old woman who presents for her yearly physical examination. Her medical
history is notable for mild depression and moderate obesity. Six months ago her fasting lipid
profile was normal. Maria report that her mother and brother have diabetes and hypertension.
She reports that she knows she should be on a low calorie, low fat diet and exercising but with
her full-time job and four children, she finds it difficult to exercise, and she eats out most of the
time. She is 67" tall and weighs 225lbs today, no current medication. She does report taking a
multivitamin daily but still feels tired, biotin Vit-C when she remembers. She is a nonsmoker,
only drinks sweet tea with each meal, 3-4 cups of coffee per day.
Today: BP 120/70 mm Hg, pulse 76, temperature 98.7, respirations 18, weight 225 pounds. Urine
dip + glucose, fasting plasma glucose 179 mg/dl, HgbA1C is 7.4%, TSH 5.6. The physical exam
is notable for acanthosis nigricans at the neck but otherwise is normal.
Acanthosis nigricans is a skin condition characterized by areas of dark, velvety discoloration in body folds and
creases. The affected skin can become thickened. Most often, acanthosis nigricans affects your armpits, groin and
neck.
The skin changes of acanthosis nigricans (ak-an-THOE-sis NIE-grih-kuns) typically occur in people who are obese or
have diabetes
BS 179
AIC 7.4%
TSH 5.6 Primary hypothyroidism?
ADA recommends one of following: AIC > 6.5% or Fasting BG > 126
GOAL: weight and glucose control. Decrease macrovascular (stroke, MI, peripheral vascular
disease) and microvascular (retinopathy and neuropathy) complications. Aic level <7%
Monotherapy ok for pts with aic <7.5%
Metformin first line tx (improves cardiac outcomes)
Dr. Moscu and class,
• What are your treatment goals for Maria?
The treatment goals for Maria are to address her current complaints of feeling tired and
her abnormal labs and weight. Maria presents today with abnormal glucose in her urine,
elevated fasting glucose of 179, elevated AIC of 7.4%, and elevated TSH of 5.6. Her
weight of 225 lbs. is also in the moderate obesity column. Her BMI is 35.2, which is
grade 2, moderately obese (Su et al., 2016). The specific plan today will be to address her
obesity status, new diagnosis of diabetes, and elevated TSH level. A thorough
https://www.coursehero.com/file/36882116/Week-5-
TDdocx/
, 2 examination of Maria will be taken to include her symptoms over the last 6 months to
validate her lab values. According to the American Diabetes Association (ADA, 2018),
with Maria’s HbgA1c (A1c) level of 7.4%, her daily average glucose levels between 154
and 183. When evaluating the A1c level, anything greater than 6.5% would be considered
https://www.coursehero.com/file/36882116/Week-5-
TDdocx/
Maria is a 46-year-old woman who presents for her yearly physical examination. Her medical
history is notable for mild depression and moderate obesity. Six months ago her fasting lipid
profile was normal. Maria report that her mother and brother have diabetes and hypertension.
She reports that she knows she should be on a low calorie, low fat diet and exercising but with
her full-time job and four children, she finds it difficult to exercise, and she eats out most of the
time. She is 67" tall and weighs 225lbs today, no current medication. She does report taking a
multivitamin daily but still feels tired, biotin Vit-C when she remembers. She is a nonsmoker,
only drinks sweet tea with each meal, 3-4 cups of coffee per day.
Today: BP 120/70 mm Hg, pulse 76, temperature 98.7, respirations 18, weight 225 pounds. Urine
dip + glucose, fasting plasma glucose 179 mg/dl, HgbA1C is 7.4%, TSH 5.6. The physical exam
is notable for acanthosis nigricans at the neck but otherwise is normal.
Acanthosis nigricans is a skin condition characterized by areas of dark, velvety discoloration in body folds and
creases. The affected skin can become thickened. Most often, acanthosis nigricans affects your armpits, groin and
neck.
The skin changes of acanthosis nigricans (ak-an-THOE-sis NIE-grih-kuns) typically occur in people who are obese or
have diabetes
BS 179
AIC 7.4%
TSH 5.6 Primary hypothyroidism?
ADA recommends one of following: AIC > 6.5% or Fasting BG > 126
GOAL: weight and glucose control. Decrease macrovascular (stroke, MI, peripheral vascular
disease) and microvascular (retinopathy and neuropathy) complications. Aic level <7%
Monotherapy ok for pts with aic <7.5%
Metformin first line tx (improves cardiac outcomes)
Dr. Moscu and class,
• What are your treatment goals for Maria?
The treatment goals for Maria are to address her current complaints of feeling tired and
her abnormal labs and weight. Maria presents today with abnormal glucose in her urine,
elevated fasting glucose of 179, elevated AIC of 7.4%, and elevated TSH of 5.6. Her
weight of 225 lbs. is also in the moderate obesity column. Her BMI is 35.2, which is
grade 2, moderately obese (Su et al., 2016). The specific plan today will be to address her
obesity status, new diagnosis of diabetes, and elevated TSH level. A thorough
https://www.coursehero.com/file/36882116/Week-5-
TDdocx/
, 2 examination of Maria will be taken to include her symptoms over the last 6 months to
validate her lab values. According to the American Diabetes Association (ADA, 2018),
with Maria’s HbgA1c (A1c) level of 7.4%, her daily average glucose levels between 154
and 183. When evaluating the A1c level, anything greater than 6.5% would be considered
https://www.coursehero.com/file/36882116/Week-5-
TDdocx/
