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
1. What nonpharmacologic treatments should be recommended to FM?
2. What pharmacologic treatments should be recommended or avoided in FM?
3. What additional laboratory tests should be recommended to FM?