Differential Diagnosis I:
Diabetes Mellitus type 2 is a disease causing an impaired ability to produce or respond to insulin resulting in hyperglycemia and insulin resistance. Includes genetic susceptibility combined with environmental determinants and risk factors such as obesity, sedentary lifestyle, diet, family history, age, ethnicity and hypertension.
Rationale: Classic symptoms of DM Type 2 is polyuria, polydipsia, polyphagia, blurred vision, fatigue, lower extremity paresthesia, and weight loss. Other symptoms may include yeast infections in females and balanitis in males as well as slow healing wounds. This patient presents with many of these risk factors including overweight, sedentary lifestyle, lack of exercise, family history and diet. He also presents with symptoms of fatigue, polyuria, blurred vision, polyphagia, and hypertension. His Hemoglobin A1C is 7.8 and is hyperglycemic.
Criteria for diagnosis of diabetes mellitus:
- Hemoglobin A1C greater than or equal to 6.5% or
- Fasting plasma glucose level of 126mg/dL (7.0mmol/L); fasting is defined as no caloric intake for at least 8 hours or
- 2 hour plasma glucose level of 200mg/dL (11.1 mmol/L) or higher during a 75-g oral glucose tolerance test (OGTT) as described by World Health Organization or
- A random plasma glucose of equal to or greater than 200mg/dL (11.1 mmol/L) or higher in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis
(McCance & Huether, 2019)
Differential Diagnosis II:
Diabetes Insipidus is an insufficiency of ADH that leads to polyuria and polydipsia. There are 3 forms consisting of neurogenic, nephrogenic, and polydipsic. All are characterized by the inability of the kidney to decrease permeability to water.
Rationale: Diabetes Insipidus must be distinguished from DM. Symptoms for DI include polyuria, nocturia, continuous thirst, polydipsia. This patient presents with polyuria and polydipsia.
Basic criteria for diagnosis of DI include: polyuria, polydipsia, low urine specific gravity (<1.010), low urine osmolality (300 mOsm or more depending on adequate water intake), and continued diuresis despite a serum sodium level of 145 mEq/L or greater.
(McCance & Huether, 2019)
Differential Diagnosis III:
Metabolic syndrome is a group of disorders (central obesity, dyslipidemia, prehypertension and elevated fasting blood glucose level)
Rationale: The symptoms of elevated blood glucose level, obesity and hypertension seen with this patient could be indicative of metabolic syndrome. Further testing would need to be completed to rule out this diagnosis. These collection of disorders can increase the patient’s risk for Diabetes Type 2 as well as cardiovascular disease.
Must meet three of the five following criteria to diagnose metabolic syndrome:
- Increased waist circumference (>40 inches in men and >35 inches in women)
- Plasma triglycerides greater than or equal to 150mg/dl
- Plasma high-density lipoprotein (HDL) cholesterol <40mg/dl (men) or <50mg/dl (women)
- Blood pressure greater than 130/85 mmHg
- Fasting plasma glucose greater than or equal to 100mg/dl
(McCance & Huether, 2019)