FM is a 52-year-old man complaining of excessive thirst. He was in his usual state of health until about 3 to 4 weeks ago when he experienced a significant weight gain that he blames on the stay-at-home order in response to the COVID-19 pandemic. He has been lonely and depressed and sitting at home “eating everything in sight.” Over the past week he has noticed increasing thirst, urinary frequency, and blurred vision.
Past Medical History
• Hypertension
• Hyperlipidemia
Medications
• Lisinopril, 10 mg daily
• Hydrochlorothiazide, 25 mg daily
• Atorvastatin, 10 mg daily
Physical Examination
• Height: 68 inches; weight: 262 lbs.; BMI: 39.8; blood pressure: 158/96; pulse: 82; respiration rate: 16; temperature: 98.2 °F
• Well-developed obese Latino male in no distress
• Lungs: clear
• Heart: regular rate and rhythm
• Extremities: no edema
• Neurological: no deficits
Labs
• Hematocrit: 42%
• Random capillary blood glucose: 358 mg/dL
• Hemoglobin A1c: 11.4% • Urinalysis: specific gravity 1.010, pH 7.4, 4+ glucose, zero acetone
Discussion Questions
- What nonpharmacologic treatments should be recommended to FM?
- What pharmacologic treatments should be recommended or avoided in FM?
- What additional laboratory tests should be recommended to FM?
