Simon Chamberlain is a 49 year-old Caucasian male client who had been in good health until about two months ago when he started to feel weak and tired more rapidly than usual. Upon questioning him, he admitted to getting up two or three times a night to urinate. He also is often thirsty at those times and drinks a glass of water each time.
Simon’s weight had been average throughout high school, where he had been on the football team. After leaving school, he had gradually gained weight over the years. His appetite remained excellent but he has noticed he is now losing weight and becoming weak.
The pain in his feet was worse at night and sometimes kept him awake. It was burning in character and sometimes his toes felt numb. The tingling and numbness in his fingers was causing him problems at his work as an auto mechanic because he frequently drops small parts or has difficulty making fine manual adjustments to engines. His vision was blurry at times, especially in the afternoon. All other symptoms were negative.
Appendectomy in 1972. No chronic illnesses. Last dental visit 6 years ago.
Both parents are deceased. His father died at age 69 from a massive stroke. His mother died at age 62 from end-stage kidney disease. She was found to have diabetes at age 48, and had a course marked by major complications including partial amputation of her right foot. She was on dialysis for three years before her death. Simon was primarily responsible for his mother’s care during her later years. He administered her insulin shots twice a day and transported her to and from the dialysis center.
Simon is the youngest of four children and weighed 10 lb 2oz at birth. Both parents were overweight, as are his siblings, two of whom have diabetes.
Social History and Habits
He is married and lives at home with his wife. He has three adult children. He works as an auto mechanic. He does not smoke. He drinks an occasional beer. He takes no medications, nutritional supplements or herbal remedies.
Physical Examination Reveals
Wt. 217 lbs., ht. 5′ 11″ (BMI 30), P 76, regular, BP 142/78
Head and neck-mild bleeding of gums reported with tooth brushing. Chest, abdomen and genital examination normal. Feet: skin dry with calluses on the medial side of the big toes. Nails normal. Pulses strong and equal.