MKSAP: 66-year-old man with polyuria and polydipsia

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 66-year-old man is evaluated in the office after being treated in the emergency department for an exacerbation of chronic obstructive pulmonary disease. While in the emergency department, he was noted to have a random blood glucose level of 211 mg/dL (11.7 mmol/L). His HbA1c was 7.8% at the time. A repeat random fingerstick blood glucose level in office is 204 mg/dL (11.3 mmol/L). The patient reports recent polyuria and polydipsia. He has lost 6 kg (13.2 lb) over the last 3 months. He has chronic epigastric pain associated with loose, oily stools due to chronic pancreatitis. He has a 20-pack-year history of tobacco use and prior alcohol use, however, he does not currently use alcohol. Current medications are enteric-coated pancreatic enzymes, vitamins, tiotropium inhaler, and an albuterol inhaler as needed. On physical examination, temperature is 37.1 °C (98.8 °F), blood pressure is 130/75 mm Hg, and pulse rate is 90/min. BMI is 22. He has mild epigastric pain on palpation without rebound tenderness or guarding. The rest of his examination is unremarkable. Which of the following is the most appropriate treatment for his diabetes? A. Exenatide B. Glipizide C. Insulin D. Metformin Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Diabetes Endocrinology Source Type: blogs