A 45 year-old man complains of constant fatigue. Despite his tanned appearance, he denies having been on vacation. During examination, pigmentation is noted on the palmar creases and buccal mucosa.
What underlying condition could be responsible for these findings?
A 56-year-old man presents for follow-up in the diabetes clinic. He was diagnosed with type 2 diabetes mellitus (T2DM) approximately 8 years ago and is currently taking gliclazide and atorvastatin. Two years ago, he underwent successful treatment for bladder cancer. However, a recent trial of metformin was discontinued due to gastrointestinal side-effects. He works as an accountant, doesn’t smoke, and has a BMI of 31 kg/m². His annual blood work reveals the following results:
– Sodium (Na+): 138 mmol/l
– Potassium (K+): 4.1 mmol/l
– Urea: 4.3 mmol/l
– Creatinine: 104 µmol/l
– HbA1c: 62 mmol/mol (7.8%)
What would be the most appropriate course of action for his management?
A 38-year-old woman with a history of type 1 diabetes mellitus is concerned about her blood sugar levels and seeks advice. What is the target blood sugar level before meals and at other times of the day (excluding mornings)?
You assess a 65-year-old man with type 2 diabetes mellitus in the diabetes clinic. His current blood pressure is 150/86 mmHg. His diabetes is well managed and there is no indication of end-organ damage. What is the recommended target blood pressure for him?
You receive a fax from outpatients requesting you prescribe dulaglutide, a once-weekly GLP-1 mimetic, for your patient Mrs. Green. Mrs. Green is a type 2 diabetic already on insulin monotherapy.
What additional benefit might a GLP-1 mimetic provide to this patient?
Samantha is a 50-year-old woman who has been diagnosed with breast cancer. She is currently undergoing chemotherapy. She presents to you with a 3-week history of constipation and nausea. Samantha has been struggling to cope and has been feeling increasingly sad and depressed. She has also noticed that her arms and legs have been aching more than usual. You order a routine set of blood tests:
Hemoglobin (Hb): 110 g/L
Platelets: 320 * 109/L
White blood cells (WBC): 3.8 * 109/L
Sodium (Na+): 138 mmol/L
Potassium (K+): 4.5 mmol/L
Urea: 5.9 mmol/L
Creatinine: 75 µmol/L
Corrected calcium (Ca2+): 3.1 mmol/L
Albumin: 32 g/L
Alkaline phosphatase (ALP): 95 U/L
Phosphate: 1.1 mmol/L
What would be the most appropriate course of action for Samantha’s management?
A 64-year-old man is being seen in a diabetes clinic due to poor glycaemic control despite weight loss, adherence to a diabetic diet, and current diabetes medications. He has no significant medical history. What medication could be prescribed to increase his insulin sensitivity?
A 58-year-old woman presents with a 6-month history of lethargy, weight gain, and cold intolerance. She had abnormal thyroid function tests 1 year ago. On examination, there are no significant findings. Repeat thyroid function tests are ordered.
1 year ago: Result Reference Range
Thyroid-stimulating hormone (TSH) 5.9mU/L (0.5-5.5)
Free thyroxine (FT4) 14.2pmol/L (9.0 – 18)
Now:
TSH 6.1mU/L (0.5-5.5)
FT4 17.1pmol/L (9.0 – 18)
What is the most appropriate course of action?
Mrs. Johnson is a type 2 diabetic who is scheduled to see the Community Diabetes Nurse because of poorly controlled HbA1c despite taking three different oral medications for her diabetes. The nurse discusses the options of starting either a GLP-1 mimetic like exenatide or starting insulin therapy. As she is an active senior citizen, she chooses to start a GLP-1 mimetic. The nurse advises her that this class of drug may cause some gastrointestinal side effects, but if she experiences severe abdominal pain, she should seek immediate medical attention.
What acute abdominal issue can arise from taking a GLP-1 mimetic?
A 47-year-old woman presents to the clinic with complaints of lethargy. During a work-up, her fasting plasma glucose level was found to be 6.3 mmol/l. The GP registrar ordered an HbA1c test to confirm the diagnosis of prediabetes. What is the most probable condition/situation that could render the test result invalid?