Case Report A6

(Laboratory interpretation report)

Name of clinician (student): _________________________________ Date: 2007 04 16.

Bjorn Toroque, 38 year old man, has a 3 weeks history of a 30 pounds weight loss,
polyuria and polydipsia. He has been urinating 2-3 times an hour for the last few weeks.
He has had some mild abdominal discomfort but no nausea or vomiting.

Additional information on request:

Physical: muscular appearing.
Afro Canadian.
Cardiac, pulmonary, abdominal and neurological examinations are within normal limits.
Medical history: none but he has not seen a physician for many years.
Medications: none.
Family history: Mother and aunt have DM type II.

Laboratory results and differential diagnosis:

Diabetes mellitus
Glucose 52 mmol/L (3.5-6.1)
Beta hydroxybutyrate 0.78 mmol/L (0.00-0.80)
Anion gap 12
Haemoglobin A1c 18% (4.8-7.8)

But what kind does he have?

(Working diagnosis underlined).

Comments, qualifications:

Further tests (more invasive or specialized) indicated:

Insulin 12.1 IU/L (0.0-20.0)
C-peptide 1.00mg/L (0.5-2.00)
Islet cell antibodies negative.

Diabetes mellitus type II.

What advice would you give him?

Diet, exercise, see an expert.

How do you think he will be treated on referral to a specialist?

Diet and exercise.
He was put on Insulin but he did not want this and over the course of 6 months gradually
reduced his doe of insulin whilst monitoring his blood glucose regularly.

Eventually insulin was discontinued. His results at that time were:

Fasting glucose 5.1 mmol/L
Haemoglobin A1c 6.3% (4.8-7.8)
C-peptide 11 ug/L (0.5-2.00)
Insulin 32 IU/L (0.0-20.0)

Reference(s):