The chosen case for this response is the 82-year-old male with diabetes reporting a weight loss of 12lbs within a month. Early in the appointment, it is essential to gather the basic information about the patient and ask about the current issue, timing and location of the problem, severity, other symptoms, and whether the patient had the intention of losing weight in the past month. Additionally, it is important to note past medical history with the exception of the already known diabetes condition. The patient’s history of surgeries, hospitalizations, injuries, trauma, and previous tests should be examined. Lastly, it is important to note changes in medication, diet, living situation, and other factors.
To gather further information on the history of the patient’s illness, it would be essential to ask questions regarding their diabetes condition. This includes inquires pertaining to glucose, such as when it is checked, what the glucose levels were during the past month, and whether the patient has experienced hypoglycemia. If the patient is using any new oral medication for diabetes or alterations in the prescriptions should be noted. Dietary questions are likely the most important in this portion of the appointment and typical foods, meals eaten this month, eating schedule, or skipped meals should be recorded. Lastly, notes of any changes or increases in levels of exercise are also crucial to know as well as current complications and issues.
The initial general exam should include an assessment of height, weight, heart murmurs, stomach, blood pressure, and flow, lungs, throat, temperature, pulse, and throat. Next, the patient’s BMI and waist circumference may be assessed to check for damage from high levels of glucose. It is also vital to check previous lab tests to see if any adjustments in diet, exercise, or lifestyle are necessary. Some additional tests such as changes in cholesterol or triglycerides or a protein in urine test may also be needed. Additionally, checking for thyromegaly, onychomycosis, striae, acanthosis nigricans, and edema or the lower extremities may assist in forming the diagnosis.
Weight loss in an elderly patient with diabetes may be caused due to multiple factors. It may be due to aspects outside of the diabetic condition such as cancer, types of dementia, gastrointestinal issues, depression, or hyperthyroidism (Dansinger, 2021). While the physical symptoms may be discovered in lab results, psychological causes should be determined by a mental health professional suggested to the patient. Physical symptoms of such a condition can be seen in the manifestation of itchy skin, excessive hunger, and thirst, excessive urination, dark skin near neck and armpits, unusual fatigue, mood changes, and yeast infections (Cotey & Harris, 2017). Some factors of the weight loss may cause positive effects, such as improved mobility, lower cholesterol, and decreased insulin resistance, though their severity should be monitored. In the case that the weight loss is related to diabetes, especially in the case that the patient has the type two variant, it may be due to ineffective insulin use and rapid fat and muscle burning.
The patient is likely suffering from complications with type two diabetes as well as rapid weight loss due to their age, which is common but addressed at first notice. However, in case the weight loss is related to an underlying illness, the patient should be scheduled for further testing, especially for cancer, hyperthyroidism, infections, and dementia. The patient may want to adjust their diet, exercise plan, lifestyle, and medication to address the weight loss if it has very severe adverse effects on their current well-being.
Cotey, S., & Harris, A. (2017). Unexplained Weight Loss? Why You Need to See a Doctor. Cleveland Clinic. Web.
Dansinger, M. (2021). Diabetes and Weight Loss. WebMD. Web.