Presentation
A Sara Thompson a 60-year-old woman with a 3-year history of diabetes was seen last week by her doctor for worsening dyspnea and cough. She has had chronic obstructive pulmonary disease (COPD) since age 55. She now has dyspnea with walking one-third of a block and a persistent cough. Her type 2 diabetes has been managed with diet and exercise. Her last glycosylated (glycosated) hemoglobin measured 1 month ago was 6.8% (normal 4–6%).
Today Sara seems anxious with a blood pressure 130/70 mmHg, pulse 120, respiratory rate 24, and weight 90 kg. You hear wheezing when she breathes, while she is resting in a chair. No cyanosis is present. O2 Sat: 88%
When she visited the doctor last week she started on albuterol inhaler 2 puffs qid. And she was also started on a course of prednisone at 40 mg/day for 3 days, tapering over 2 weeks. Today when she checked her blood glucose level is 12mml/L at 8:00 a.m.
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