Patient with a long-term history of obesity
Dr Pepper is a 57-year-old man who was diagnosed 2 years ago with insulin resistance. At the time, he had an extremely poor diet with a sedentary lifestyle, and he smoked a pack of cigarettes a day. He was told that he needed to modify his diet under the advice of a nutritionist, and recommended to make some lifestyle changes that included gentle exercise.
He presents to you today on his wife’s insistence, complaining of fatigue and an increased frequency of urination. He says he has followed your advice ‘to the letter’ and has reduced his smoking to 5 cigarettes/day.
During his physical examination, you note that:
• Height: 180cm, BMI 32 ( BMI 28 on previous visit)
• BP of 160/100 mmHg
• Regular pulse of 87 bpm.
You also take a blood and urine sample to check up on his insulin resistance. Laboratory investigations reveal:
Urinalysis: Blood serum analysis:
• Glucose present • Blood Urea Nitrogen (BUN) of 16 mg/dl
(normal range: 7–30 mg/dl)
• Serum creatinine of 1.4 mg/dl (normal range: 0.5–1.4 mg/dl)
• Random serum glucose of 169 mg/dl
• HbA1c is 10% (normal: 4–6%)
Questions:
1. Based on the patient’s history, explain what you think his condition may be, and give reasons and supporting case evidence for your decision.
2. Explain how the patient’s risk factors have contributed to the progressive development of his current presenting symptoms.
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