A 36-Year-Old Man With Fatigue, Increased Thirst, and Leg Cramps

Romesh Khardori, MD, PhD


February 09, 2017

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A 36-year-old white man presents to a walk-in clinic with fatigue, increased thirst, and leg cramps for the past several months. He reports feeling warm and having cough with expectoration for the past 10 days. He was informed that he has diabetes and hypertension (blood pressure, 140/90 mm Hg) and was advised to watch his diet, lose weight, and check weekly fasting blood glucose levels. He was placed on metformin (500 mg twice daily). His fasting blood glucose level has steadily increased; 4 months prior, his glycated hemoglobin level was 8.3%. Insulin glargine (30 U at bedtime) was added to his treatment protocol. He denies any other medical problems and is a nonsmoker. He also states that he is not able to lose weight, despite his efforts.


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