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Background
Patient V.G., a 47 year old African American male, was diagnosed two years ago with type II diabetes. During a follow up, the patient complained of increased tingling in lower extremities. His medical history shows high or abnormal cholesterol levels (dyslipidemia, hypertension (HTN), obesity, and former smoking habits (stopped 2 years ago). He has no declared history of alcohol use. Living alone in subsidized housing and relying on food stamps and welfare, on occasion he works for extra income.
The potential reason for the complaint of tingling lower extremities could come from not taking his medications for almost a week. He takes several medications: Lisinopril 20mg, Januvia 50mg QD, Lipitor 40mg QD and has a high blood pressure of 160/100. Lipitor is a known cholesterol lowering drug. Doctors prescribe Lisinopril to treat high blood pressure. Januvia helps lower blood sugar and therefore provides some relief for his type II diabetes. Without these medications, already one sees high blood pressure. His blood sugar must be tested along with his cholesterol levels to see if they have risen. The primary concern however, is the elevated blood pressure and the potential elevated blood sugar from immediately stopping medications.
Although high blood sugar can cause tingling in...
Perhaps lifestyle choices have mitigated the positive effects of Januvia. Peripheral neuropathy is conditions resulting when there is damage to the nerves from the spinal cord and brain that carry signals to the rest of the body. The lower extremities like the feet and hands experience weakness, numbness and tingling that can then lead to other problems as the condition worsens. This is a common complication that happens when a person develops type II diabetes (Vallat & Weiss, 2014).
Personal, Medical, and Family History
Personal history has been given, but not to the point where one can see what kind of lifestyle choices the patient makes on a daily basis. For example, if patient eats a high sugar diet and does not get enough exercise, a medication like Januvia will fail to reduce the high blood sugar. Additionally, the patient has not described what kind of stress level he experiences when he does ‘occasionally’ work what foods he buys on a weekly or monthly basis. This information could provide clues as to what his primary diet is like and how long he has maintained it. If it is a poor diet…
References
Buttaro, T. M. (2013). Primary Care: A Collaborative Practice. St. Louis, MO: Elsevier Health Sciences.
Lerma, E. V., & Batuman, V. (2014). Diabetes and Kidney Disease. Basingstoke, England: Springer.
Vallat, J., & Weiss, J. (2014). Peripheral Nerve Disorders: Pathology and Genetics. Hoboken, NJ: John Wiley & Sons.
Wiesman, J. F. (2016). Peripheral Neuropathy: What It Is and What You Can Do to Feel Better. Baltimore, MD: JHU Press.
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