The patient is a 48 y/o obese female with known HTN and high cholesterol, diagnosed about 3 years ago

The patient is a 48 y/o obese female with known HTN and high cholesterol, diagnosed about 3 years ago. She only seeks medical care when she does not feel well, but she completes annual health screenings offered through her employer. At the last screening she was told her fasting blood sugar was 141 and her total cholesterol was 225. She felt fine at the time and decided to not seek follow-up care. She has had several “female infections” that she treated with Monistat but overall feels she has been “doing good” until recently. She has been very thirsty lately and gets up more at night to urinate. She feels tired and fatigued. She has gained 65 pounds since her last pregnancy 14 years ago, with 15 pounds in the last 6 months alone. Admits she has been snacking frequently due to working from home. She has a younger sister and grandmother with Type 2 DM. On physical exam you note dry mucous membranes and a bruit over the right carotid artery. Her feet are cool to touch, dry with cracking, and decreased sensation to light touch in both feet. VS: BP 165/100, P 88 regular, T 98.0, RR 15 non-labored;