Mr.Joseph:45-years-old man

Pathophysiology

Genetic predisposing constitutional factors

Insulin resistance

Beta cell dysregulation

Impaired glucose tolerance

Beta cell insufficiency

Diagnosis

Type 2 diabetes mellitus

Peripheral neuropathy

Diabetic ulcer

Signs and symptoms

Dry skin

Polyuria

Nocturia

Polydipsia

Polyphagia

Craving for sweet food

Lab investigations

Physical examination

Obese (BMI : 32kg/m2)

Small ulcer at 2nd interdigital cleft of the left foot

Dry skin over both legs

Bilateral peripheral pulses of dorsalis pedis and posterior tibial artery are palpable

Diminished sensation on the dorsum of the foot on soft touch

Lipid profile

High total cholesterol

High triglycerides

Low HDL cholesterol

High LDL cholesterol

Blood glucose and HbA1c test

High fasting plasma glucose

High postprandial plasma glucose

High HbA1c

Treatment and management

Biguanides - Inhibit hepatic and renal gluconeogenesis

Metformin - Reduce postprandial and fasting glucose levels. Decreases glucose production, decreases intestinal absorption of glucose , reduced plasma glucagon levels and improve insulin sensitivity by reducing endogenous insulin production

Follow a healthy lifestyle

Monitor or control blood glucose at home

Follow the Mediterranean diet

Quit smoking