Mr. F. was diagnosed with type 2 diabetes mellitus at age 46. Atthat time, he was overweight, enjoyed foods with high carbohydrateand fat content, and led a sedentary life. His family historyindicated that his mother and his brother had diabetes. Weightloss, appropriate diet, and exercise were recommended to reduceblood glucose levels.

1. List the factors contributing to diabetes mellitus in thiscase.

At age 50, Mr. F. noticed that his vision was cloudy,particularly in one eye. Cataracts were removed from both eyes.

2. Describe a cataract, and explain how diabetes promotescataract formation.

3. Glyburide (DiaBeta) was prescribed at this time. Describe theaction of this drug.

At age 56, a blister developed on the heel of one foot, whichdid not heal. An ulcer formed and persisted. Finally the foot wasplaced in a cast for 13 weeks to promote healing.

4. Explain several factors contributing to the delayed healingin Mr. F.

5. Why was it necessary in this case to remove the cast andreplace it each week?

Peripheral neuropathy with total loss of sensory function haddeveloped in both feet. Motor function was not directly affected.Orthopedic shoes were ordered and arrangements made for apodiatrist to provide regular foot care.

6. Why is it essential that Mr. F. examine his feet carefullyeach day?

At this time body weight had again increased substantially andblood pressure was elevated. Fosinopril (Monopril) was prescribed,along with recommendations for weight loss and regularexercise.

7. Describe the usual manifestations of hypertension.

At age 60, routine monitoring during a workout at the healthclub indicated atrial fibrillation. During consultation, thecardiologist also noted his blood pressure was very high.

8. State the purpose of the following medications prescribed atthis time (see Chapter 18): fosinopril (Monopril), atorvastatin(Lipitor), amlodipine (Norvasc), warfarin (Coumadin), and sotalol(Sotacor).

Since that time, continued regular exercise and dietarymodification have maintained weight at recommended levels. Bloodpressure is within normal range, HbA_1c is below 7, andatrial fibrillation is controlled.

9. What does this HbA_1c value mean?

10. Why does Mr. F. bruise easily? What precautions would beadvisable at this time?

11. Briefly review the effects of diabetes over time in thiscase.