BMI
The body mass index (BMI) is an important index for relating weight to height. It is a measurement that is a weight-to-height ratio. It is a better way to see whether our weight is proportionate to our height. BMI, formerly known as the Quetelet index, is a metric used to assess an individual's nutritional status. A high BMI can indicate a high level of body fat. Indeed, knowing our BMI can help us determine any health risks we may face if it is above the healthy range. Adults with a BMI between 25 and 29.9 are classified as overweight; an adult with a BMI of 30 or above is classified as obese; a BMI less than 18.5 is considered underweight, and a BMI between 18.5 and 24.9 is considered healthy.
Obesity
Obesity is when excess fat is stored in adipose tissue resulting in an increase in weight and clusters of health problems like diabetes, cancer, and heart diseases. Mostly high intake of calories gives rise to obesity. Calculating BMI, skinfold test, waist to hip comparison, and screening test are ways to diagnose obesity.
Question: Would you add medications to address the pt’s lipid profile? If so, what would you add?
CC: My blood sugars have not been very good lately. I’m doing everything I am supposed to be doing
HPI: A 24-year-old male patient comes to your primary care clinic to establish care. He has type 1 diabetes mellitus diagnosed at age 11. He has not seen a provider in about 9 months. Currently, he is taking NPH insulin 30 units bid (8 a.m. and 6 p.m.) with 10 units Humalog before each meal. He does not take any other medications. He does not use tobacco products but does drink alcohol on the weekends. He reports checking blood glucose (BG) levels three to four times daily but did not bring his glucose log or meter. He reports his fasting blood sugar runs 150 to 190 and prandial glucose readings are 140- 250. He reports hypoglycemic episodes one to two times per week. He exercises intermittently but is not on a regular schedule. He does not eat on a regular schedule every day although he says he knows that he should. He works at a light-activity job 8 hours daily. Reports fatigue and nausea at times. Unsure of polydipsia or polyuria. Denies fevers, chills, weight loss, malaise, SOB, palpitations, dizziness, headache, constipation, and diarrhea.
PmHx: DM type 1
Meds: NPH insulin 30 units BID, and Humalog 10 units with meals
Allergies: NKDA
Vital Signs: BP = 128/78 HR = 76 RR = 20 Wt = 200 lbs Ht= 5’10”
Physical Exam: no abnormalities except
Labs:
|
Na |
136 |
Hgb |
13.8 |
TSH |
2.4 |
|
K |
4.8 |
Hct |
39.4 |
Total chol |
209 |
|
BUN |
23 |
WBC |
4.5 |
LDL |
103 |
|
Creatinine |
1.4 |
A1c |
9.8 |
HDL |
55 |
|
Glucose |
240 |
|
|
TG |
180 |
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