Читать книгу Handbook of Diabetes - Rudy Bilous - Страница 17

A 66‐year‐old retired policeman attends his family doctor for a routine BP check. He has had hypertension for 4 years. He reports incidentally that he has been feeling generally tired and lethargic. On further questioning, he admits to nocturia x3 and volunteers that in recent months he has been taking a glass of water to bed since he often wakes feeling thirsty. The GP notices that he had a cutaneous boil lanced 6 weeks ago. Apart from hypertension, there is no other significant past medical history, but his body weight has gradually risen (95kg, BMI 32). He takes an ACE inhibitor, lisinopril 10mg, for hypertension. His mother had type 2 diabetes, he is a non‐smoker and drinks 15 units of alcohol per week. His only exercise is golf, twice per week. The doctor takes a random venous blood sample, which shows a plasma glucose level of 13 mmol/L. Further blood tests show a normal haematology profile, normal electrolytes and renal function, HbA1c 8.3%, and fasting lipids show total cholesterol 6.6mmol/L, LDL‐cholesterol 4.3mmol/L, triglycerides 3.9mmol/L and HDL‐cholesterol 0.6mmol/L. Minor abnormalities of liver function are also noted (AST & ALT 2‐3x upper limit).

Comment: This man presents with typical symptoms of type 2 diabetes and several risk factors (age, obesity, hypertension, family history). The random plasma glucose and HbA1c in the context of symptoms, is diagnostic. He has features of the metabolic syndrome, including hypertension, dyslipidaemia (high triglycerides and low HDL‐cholesterol) and central obesity, and fatty infiltration of the liver is common in this scenario. Susceptibility to infections is typical.