J.S. is a 39-year-old male truck driver who presented to the emergency room (ER) on a Friday night complaining of polyuria, polydipsia, and fatigue of 2 weeks’ duration. He also reported a 15- to 20-lb. weight loss over the past 1-2 months. He denied any antecedent acute illness and had not been diagnosed with any chronic medical conditions. He had no known allergies and was taking no medications.
The patient’s mother died at age 75 with Alzheimer’s disease and alcoholic cirrhosis. His father died from prostate cancer at age 79. There was no family history of diabetes, hypertension, or heart disease. He reported smoking a half-pack of cigarettes per day, drinking 1-2 beers nightly, and bingeing with two 12 packs of beer on most weekends.
J.S. weighed 228 lb. (104 kg) and is 5′11″ in height. His BMI is, therefore, 32 kg/m2. He was afebrile, and his blood pressure was 132/82 mmHg. His physical exam was remarkable only for signs of mild dehydration.
The patient’s serum test results were as follows: glucose, 682 mg/dl; sodium, 131mEq/l; potassium, 3.6 mEq/l; CO2, 25 mEq/l; creatinine, 1.4 mg/dl; ketones, negative; and hemoglobin A1c (A1C), 11.7% His hepatic chemistries were normal. Urine ketones were 40 mg/dl, and urine glucose was > 1,000 mg/dl.