“I’ve been waking up at night with a burning and tingling feeling in my fingers and toes.”
History of Present Illness
AP is a 64-year-old African American male who presents to the primary care clinic with a glucometer and medication list. The patient states that he has been adherent to his medications including insulin glargine, metformin, and his newly prescribed dulaglutide. The patient states that he has been attempting to “live healthier” by jogging 30 minutes at least four times a week and minimizing fast food. Of note, the patient reports experiencing distal symmetric peripheral neuropathy (DSPN) over the last year in the tips of his fingers and toes that wakes him up at night. The patient also states that he has been experiencing bloating, nausea, and vomiting over the past 6 months, however the vomiting has become more pronounced over the past 3 months, especially after eating meals.
Type 2 diabetes (diagnosed 2001)
Mother: history of T2DM, alive at 96 years of age
Lives with wife of 30 years.
Drinks beer occasionally.
No cigarette or recreational drug use.
Atorvastatin 40 mg, 1 tablet PO daily
Clopidogrel 75 mg, 1 tablet PO daily
Insulin glargine 100 units/mL, 32 units SC QPM
Dulaglutide 0.75 mg/0.5 mL, 0.75 mg SC once weekly (initiated 2 months ago)
Amlodipine 5 mg, 1 tablet PO daily
Levothyroxine 50 mcg, 1 tablet PO daily
Losartan 100 mg, 1 tablet PO daily
Metformin 1000 mg, 1 tablet PO bid
Metoprolol succinate, 1 tablet 50 mg daily
Multivitamin, 1 tablet PO daily
Temp 99.1, P 78, RR 18, BP 128/86 mmHg, Ht: 5′9″, Wt: 185 lbs
No sore throat, oral ulcers or pain, or trouble swallowing.
No change in hearing/vision.
CTAB. No cough or shortness of breath.