You are seeing a 64-year-old Hispanic male for his diabetes management. He reports that his morning capillary blood sugar readings are ranging in the 150 to 190 range.

You are seeing a 64-year-old Hispanic male for his diabetes management.  He reports that his morning capillary blood sugar readings are ranging in the 150 to 190 range.

Last month his Hgb A1C was 7.4

He is on Metformin 1000mg twice a day and Glipizide 5mg daily.

He walks a couple miles three to five times a week.

A dietary review reveals that his daily total carbohydrate intake is in the range of 75 to 100 grams.

Last eye exam did not reveal any problems.  He wears reading glasses when needed.

He does report some intermittent burning sensation in his feet.

Ht 6’2”, Wt 200 lbs, BP 118/72, P 72, R 17

Heart regular rhythm, without murmur or gallop

Lungs clear

Monifilament testing does not reveal any decreased sensation in the feet

Please develop a discussion that responds to each of the following prompts.  Where appropriate your discussion needs to be supported by scholarly resources.  Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

DQ2 Treatment of Hypothyroidism

Scenario: You are evaluating a 53-year-old white female who wants to talk to you about lab work that she had done recently at “Any Lab Test Now”.

She wanted to have lab work done because she was feeling tired and unmotivated.  Additionally, she had put on about 15 pounds even though she has been teaching yoga 2-3 times a week for the last few years.

The lab results reveal a TSH of 93.

She reports her last menstrual period was about 3 years ago.  She experienced some menopausal symptoms of hot flashes and night sweats.  However, she states they weren’t too much of a problem and those resolved a couple years ago.

She denies any difficulty swallowing or neck pain/tenderness.

Constitutional exam: 5’5” tall, 154 pounds, BP 145/88, P 60, R 16, Temp 97.2

Neck – nontender, mild goiter with right side of thyroid larger than the left side

Heart – regular rhythm without murmur or gallop

Lungs – clear

Skin – dry on extremities with some flaking noted

A slowness of the relaxation phase of the Achilles tendon reflex is noted

Please develop a discussion that responds to each of the following prompts.  Where appropriate your discussion needs to be supported by scholarly resources.  Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

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