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After completing this case study, the reader should be able to:

  • Recognize the signs, symptoms, and risk factors associated with type 2 diabetes mellitus (DM).

  • Identify the comorbidities in type 2 DM associated with insulin resistance (metabolic syndrome).

  • Compare the pharmacotherapeutic options in the management of type 2 DM including mechanism of action, contraindications, and side effects.

  • Develop appropriate educational information for a patient regarding self-monitoring of blood glucose (SMBG).

  • Design a patient-specific pharmacotherapeutic plan for the treatment and monitoring of type 2 DM.


Chief Complaint

“My vision has been blurred lately and it seems to be getting worse.”


Alfonso Giuliani is a 68-year-old man who presents to his family physician’s office complaining of periodic blurred vision for the past month. He further complains of fatigue and lack of energy that prohibits him from working in his garden and participating in physical activity.


HTN × 18 years

Dyslipidemia × 8 years

Gouty arthritis × 16 years with complicated course of uric acid urolithiasis

Hypothyroidism × 15 years

Overweight × 25 years


Diabetes present in mother. Immigrated to the United States with his mother and sister after their father died suddenly from unknown causes at age 45. One younger sibling died of breast cancer at age 48.


Retired candy salesman, married × 46 years with three children and two grandchildren. No tobacco use. Drinks one to two glasses of homemade wine with meals. He reports adherence with his medications.


Lisinopril 20 mg PO once daily

Allopurinol 300 mg PO once daily

Levothyroxine 0.088 mg PO once daily




Occasional polydipsia, polyphagia, fatigue, weakness, and blurred vision. Denies chest pain, dyspnea, tachycardia, dizziness or lightheadedness on standing, tingling or numbness in extremities, leg cramps, peripheral edema, changes in bowel movements, GI bloating or pain, nausea or vomiting, urinary incontinence, or presence of skin lesions.



The patient is a centrally obese, Caucasian man who appears to be restless and in mild distress.


BP 124/76 mm Hg without orthostasis, P 80 bpm, RR 18, T 37.2°C; Wt 77 kg, Ht 66″; BMI 27.4 kg/m2

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