Skill Checkup: Man With a History of Type 2 Diabetes Complicated by Peripheral Neuropathy Presents With New Dyspnea

Alanna Morris, MD


January 27, 2022

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 66-year-old man has an 8-year history of type 2 diabetes complicated by peripheral neuropathy and hypertension. The patient is 5' 6" and weighs 270 lb; his BMI is 44. He is a former smoker (45 pack-years) and reports drinking two or three alcoholic beverages most nights (more on the weekends). Current medications are lisinopril 80 mg/d and metformin 1500 mg/d. His most recent lab tests revealed an A1c value of 8.6%, high-density lipoprotein cholesterol level of 200 mg/dL, low-density lipoprotein cholesterol level of 138 mg/dL, and serum creatinine level of 1.2 mg/dL.

The patient presents with dyspnea, wheezing, lightheadedness, and profuse sweating. He is very agitated and anxious. He denies any current pain but reports having sudden onset of burning chest pain and severe indigestion the night before that lasted for approximately 1 hour. Physical examination reveals tachycardia, palpable peripheral pulses, peripheral edema, and a palpable S4 gallop. His body temperature is 98.4 °F, and his blood pressure is 151/88 mm Hg in the right arm and 150/86 mm Hg in the left arm.


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