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Chapter 43. Diabetes Mellitus

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A 46-year-old man presents for his annual physical. He states that he has been going to the bathroom more frequently than normal and has lost approximately 20 pounds (9.1 kg) in the past 6 months without trying. His random glucose today is 252 mg/dL (14.0 mmol/L). Which of the following is most appropriate to confirm diagnosis of type 2 diabetes?

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A. Obtain a fasting glucose level in the morning.

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B. Have patient perform a 2-hour oral glucose tolerance test.

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C. Obtain patient’s hemoglobin A1c.

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D. Obtain a repeat random glucose level.

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E. Nothing; there is enough information available to diagnose patient with type 2 diabetes.

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A 36-year-old Caucasian woman is concerned about her risks for developing type 2 diabetes because her mother and father have the disease. Currently, she weighs 145 lbs (66 kg; BMI = 22 kg/m2) and has no other medical conditions. All of her children weighed less than 8 lbs (3.6 kg) at birth and she is preparing for her second marathon. The most appropriate recommendation for screening is to begin:

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A. At the age of 45 then every 3 years if normal.

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B. At the age of 45 then every year if normal.

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C. At the age of 40 then every 3 years if normal.

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D. At the age of 40 then every year if normal.

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E. As soon as possible then every year if normal.

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A 67-year-old Caucasian woman has been recently diagnosed with type 2 diabetes. Her past medical history is significant for hypertension, hyperlipidemia, and hypothyroidism. Her current medications include hydrochlorothiazide, levothyroxine, and simvastatin. At diagnosis, her vitals and labs were as follows: BP 157/94 mm Hg, Wt 157 lbs (71 kg; BMI = 24 kg/m2), A1c 8.7% (0.087; 72 mmol/mol Hgb), FPG 174 mg/dL (9.7 mmol/L), LDL 52 mg/dL (1.34 mmol/L), HDL 59 mg/dL (1.53 mmol/L), TG 45 mg/dL (0.51 mmol/L).

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Which of the following is the most appropriate recommendation for therapy according to the ADA algorithm?

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A. Lifestyle changes only

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B. Metformin only

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C. Intensive insulin only

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D. Lifestyle changes and metformin

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E. Lifestyle changes and intensive insulin

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A ...

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