Your 65 year old patient is here for a 6 month check. He was diagnosed with type II DM (NIDDM) 10 years ago. Blood sugars were variable for the first 2 years after diagnosis but have been relatively stable since. He notes more frequent urination for the past month. He lives by himself in a one-story home. He works full time as a janitor, he smokes 1ppd and drinks 2-3 beers per day. BP is 146/94.
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Based on the given information, it is important to consider the patient’s symptoms, medical history, and lifestyle factors to determine the potential cause of the increased frequency of urination.
One possible explanation for the patient’s increased urination could be related to his longstanding diagnosis of type II diabetes mellitus (NIDDM). Diabetes can cause increased urination due to elevated blood sugar levels, which leads to the kidneys filtering and excreting more urine. This symptom may indicate that the patient’s diabetes is not well controlled or that there may be a new issue affecting his blood sugar levels.
Additionally, the patient’s blood pressure reading of 146/94 is considered elevated and indicates hypertension. Hypertension is a common comorbidity in individuals with type II diabetes. The combination of uncontrolled diabetes and hypertension can contribute to kidney damage, which can further increase urine production.
The patient’s lifestyle factors, such as smoking and alcohol consumption, may also play a role in the increased urination. Both smoking and excessive alcohol consumption can affect kidney function and exacerbate existing health conditions, including diabetes and hypertension.
Considering all these factors, it is crucial to address the patient’s increased urination promptly to prevent further complications. This may involve evaluating and adjusting his diabetes and hypertension management, promoting lifestyle modifications (such as smoking cessation and limiting alcohol intake), and monitoring kidney function through appropriate tests and follow-up examinations. Providing patient education on the importance of medication adherence, regular medical check-ups, and a healthy lifestyle is also essential in managing and preventing complications associated with diabetes and hypertension.
Overall, this case highlights the complex nature of managing a patient with multiple chronic conditions and emphasizes the importance of a comprehensive and individualized approach to care.