Alterations of the Endocrine Function

C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had high blood

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sugar and cholesterol levels three years ago but did not follow up with a clinical diagnostic work-up. She

had participated in the state’s annual health screening program and noticed that her fasting blood sugar

was 141 and her cholesterol was 225. However, she felt “perfectly fine at the time” and could not afford

any more medications. Except for a number of “female infections,” she has felt fine until recently. Today,

she presents to the Indian Hospital general practitioner complaining that her left foot has been weak and

numb for nearly three weeks and that the foot is difficult to flex. She denies any other weakness or

numbness at this time. However, she reports that she has been very thirsty lately and gets up more often

at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more

water to keep hydrated. She has gained a total of 65 pounds since her last pregnancy 14 years ago, 15

pounds in the last 6 months alone.

1. Clinical signs are objective manifestations of a disease that can be identified by someone other than the

patient. List a minimum of four signs from the case study above that support a diagnosis of type 2 diabetes

in this patient.

2. Why do stress and infection promote hyperglycemia in patients with diabetes?
3. Why should medications other than glipizide or glyburide be considered for management of diabetes in

this patient?

Sample Solution

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