Diabetes associated with ...

A retired 69-year-old man presented to a nurse practitioner’s clinic with a 5-year history of type 2 diabetes. Although he was diagnosed in 1997, he had symptoms indicating hyperglycaemia for 2 years before diagnosis. He had fasting blood glucose records indicating values of 118–127 mg/dl, which were described to him as indicative of “borderline diabetes.” He presented with recent weight gain, suboptimal diabetes control, and foot pain. He has been trying to lose weight and increase his exercise for the past 6 months without success. He had been started on glyburide (Diabeta), 2.5 mg every morning, but had stopped taking it because of dizziness, often accompanied by sweating and a feeling of mild agitation, in the late afternoon. He took atorvastatin (Lipitor), 10 mg daily, for hypercholesterolemia. He tolerated this medication and adhered to the daily schedule. During the past 6 months, he has also taken chromium picolinate, gymnema sylvestre, and a “pancreas elixir” to improve his diabetes control. He stopped these supplements when he did not see any positive results. His diet history revealed excessive carbohydrate intake in the form of bread and pasta.