Case Study: A 68-Year-Old Man With Diabetes and Peripheral Neuropathy

Abstract

C.T. is a 68-year-old man with a 3-year history of impaired glucose tolerance. His only other medical problem is hypertension treated with a small dose of an angiotensin-converting enzyme (ACE) inhibitor. He quit smoking 20 years ago. He has no dyslipidemia and has had stress electrocardiograms every 2 years with normal results. He uses no alcohol.He is retired from an office job with the government and presently teaches part-time at a local college. His glucose intolerance was discovered on routine laboratory testing. He was sent for diabetes education, learned home glucose monitoring, and followed a diet and exercise program suggested by our diabetes educator. He was not obese and led a physically active life, playing golf frequently and taking vigorous walks almost daily. He lost 10 lb and was able to normalize his blood glucose levels with this regimen.Approximately 3 months ago, he noticed some burning and tingling in his feet. He admitted that he had not felt as well as usual and that his walking was becoming more of a chore. He denied chest pain or shortness of breath. He denied any other symptoms and had no fever or chills, cough, bloody stools, or hematuria. When seen in the office, he had gained 5 lb. His physical examination was normal except for some hyperesthesia of both feet as well as decreased vibratory sensation. His thyroid, reflexes, and pulses …