Type 2 Diabetes Mellitus

Instructions: Please respond to at least 2 of your peers posts. Watch the video submission from your peers and reply in a written format. Responses need to demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the students position. Peer one Subjective: Today, I am presenting a 53-year-old African American male seen in clinic with a chief complaint of bilateral lower extremity neuropathy. He describes persistent numbness and tingling in both feet that have gradually worsened. He states the sensation is worse at night and sometimes interferes with sleep. He denies recent injury, swelling, redness, or open wounds. His past medical history is significant for Type 2 diabetes mellitus, hypertension, hyperlipidemia, and coronary artery disease. His current medications include metformin 500mg daily and 15 units of Lantus qHS for diabetes management, lisinopril 10mg for BP control, atorvastatin 10mg for hyperlipidemia, and aspirin 81mg daily for cardiovascular protection. He reports generally taking his medications but admits his blood sugars are often higher than they should be, ranging between 185-210 Social history reveals he lives with his spouse and works a mostly sedentary job. He has a prior smoking history of about 20 pack-years but quit 7 years ago. He drinks alcohol occasionally and denies illicit drug use. His diet is high in processed foods, and he reports limited physical activity. He denies chest pain, shortness of breath, vision changes, or recent hospitalizations. His main concern today is the loss of sensation in his feet and the fear of complications. Objective: Upon examination, the patient is alert and in no acute distress. Vital signs: BP 142/88, HR 78bpm, Resp 16, Temp 98.9. Hes 75in tall and weighs 252lbs Cardiovascular exam reveals regular rate and rhythm without acute abnormalities. Peripheral pulses are present but slightly diminished in the BLE. Neurological exam shows decreased sensation to light touch. Skin is intact with no ulcers, calluses, or signs of infection. Most recent labs show an elevated hemoglobin A1C of 9.6%, indicating suboptimal glycemic control, along with lipid levels consistent with his hyperlipidemia history. Assessment: This patients presentation is most consistent with diabetic peripheral neuropathy, a microvascular complication of long-standing Type 2 diabetes. Chronic hyperglycemia leads to nerve ischemia and metabolic injury, resulting in the bilateral, symmetric sensory changes noted. His comorbid conditions, hypertension, hyperlipidemia, obesity, and coronary artery disease, further increase vascular damage and contribute to the progression of neuropathy. Other differentials considered include peripheral arterial disease and vitamin deficiencies, but the distribution of symptoms and his diabetes history strongly support diabetic neuropathy as the primary diagnosis. Plan: Management will focus on both symptom control and risk factor modification. First, we emphasized that improved glycemic control is the most important strategy for slowing neuropathy progression. Medication adherence, dietary changes, and regular blood glucose monitoring were reinforced. For neuropathic discomfort, we discussed first-line options such as duloxetine or pregabalin, which are evidence-based treatments for diabetic neuropathic pain. A comprehensive foot exam was completed today, and the patient was educated on daily foot inspection, proper footwear, and avoiding barefoot walking to reduce the risk of ulcers and amputation. Blood pressure and lipid management were reinforced, including continued use of lisinopril and atorvastatin, and cardiovascular protection with aspirin as prescribed. Lifestyle counseling included increasing physical activity, reducing processed foods, weight management, and smoking cessation reinforcement, even though he is a former smoker. Follow-up is planned in 3 months to reassess symptoms, monitor A1C, and continue diabetic foot care Peer two Type 2 Diabetes Mellitus (T2DM) is a common endocrine and metabolic disorder characterized by hyperglycemia resulting from insulin resistance and relative insulin deficiency. Patients often present with nonspecific symptoms such as fatigue, polyuria, and polydipsia, which can develop gradually over months. Early recognition and intervention are critical in preventing complications such as cardiovascular disease, neuropathy, retinopathy, and nephropathy. In a recent clinical encounter, a 52-year-old male presented with fatigue, increased thirst, and frequent urination for the past three months. Using the OLDCART framework, the onset was gradual, symptoms occurred daily, and were worsened after meals high in carbohydrates. He reported mild relief with fluid intake but noted occasional blurred vision. His past medical history included hypertension and hyperlipidemia, managed with lisinopril and atorvastatin. He had no known drug allergies. Family history was significant for a father with T2DM. Socially, the patient does not smoke, consumes alcohol occasionally, and engages in moderate exercise. Objective findings included a blood pressure of 138/86 mmHg, heart rate of 78 bpm, respiratory rate of 16, temperature 98.6F, oxygen saturation 98%, height 510, weight 210 pounds, and BMI 30.1, indicating obesity. On physical examination, the patient was alert and oriented, appeared overweight, but exhibited no acute distress. Cardiovascular, respiratory, abdominal, and neurological exams were unremarkable. Based on the patients history, risk factors, and presentation, the primary assessment was suspected T2DM, with hypertension noted as a secondary chronic condition. Laboratory testing, including fasting blood glucose, HbA1c, lipid panel, and renal function tests, was planned to confirm the diagnosis and assess for complications. Therapeutic planning included patient education on lifestyle modifications, including diet and exercise, and consideration of metformin pharmacologic therapy if laboratory results confirmed T2DM. Additionally, a referral to a dietitian was provided to support individualized nutritional counseling. Preventive measures were emphasized, including routine foot care, retinal exams, blood pressure monitoring, and adherence to vaccination guidelines in accordance with USPSTF recommendations. Early recognition and management of T2DM are critical for reducing complications and improving patient outcomes. Comprehensive assessment, patient education, and preventive care remain essential components in managing endocrine and metabolic disorders (Waheed et al., 2024; Liu et al., 2024).