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Chris Padilla
Chris is a 15-year-old male who was diagnosed with type 1-diabetes at age 11. His diabetes has been poorly controlled, with an A1c routinely greater than 8%. He has gained approximately 30 pounds over the past 2 years and has now developed hypertension. He plays football and he says he doesn't want to lose weight because he wants to be "bigger for football." He regularly sees the dietitian and social worker, but they are frustrated regarding his compliance and progressive weight gain. His dietary management has primarily involved calorie and carbohydrate counting.
Medical History:
Born preterm at 31 weeks gestation.
Type-1 diabetes at 11 years old.
Hypothyroidism at 13 years old.
Immunizations:
Up-to-date.
Allergies:
No known drug, food or environmental allergies
Medications:
Vasotec 5 mg bid
Levoxyl 75 mcg qd
Lantus insulin 68 U qd
Humalog insulin typically 16 units at breakfast and 14 at lunch and dinner (adjusting 1U/5gms carbs)
Family Medical History:
Obesity in both parents and grandparents. Documented type 2-diabetes in grandmother and suspected insulin resistance in parents. Prostate cancer in paternal grandfather and grand uncle. Hypertension in multiple family members on both sides.
Social History:
Chris is a freshman in high school and lives with his parents, sister and paternal grandparents. He appears to be particularly close with his mother. Eats breakfast at home, lunch at school and often eats out for dinner. He likes fast food, cola drinks, fruit and pastries. He does not like seafood.
Physical Activity:
Chris has been active in basketball and football. He has been limiting his activity lately because his weight has been an issue. He does not have a set exercise schedule.
Sleep:
Reports he sleeps well. Needs < 7-8 hours a night to feel rested. No daytime sleeping. No overt snoring has been noted.
Relaxation:
No specific relaxation techniques. Says he watches quite a bit of TV. Not uncommonly < 4-6 hours per day.
Spirituality:
Chris describes himself as believing in God and having a "spiritual side". He doesn't practice a formal religion.
Physical Exam:
Vitals: HR 86, RR 18, BP 132/78, height 180.5cm; (75-90%), weight 140kg (<95%), BMI 43
HEENT: Pupils equal and reactive, Tympanic membranes normal, oropharynx clear.
Neck: supple, no thyromegaly.
Heart: regular rate and rhythm, no murmur.
Lungs: Cleat to auscultation.
Abdomen: Soft, markedly obese with striae. Non-tender.
Extremities: no edema, pulses normal.
GU: circumcised, Tanner4-5, testis descended.
Labs:
Sodium 130, Potassium 5.2, Chloride 97, Bicarb 22, BUN 10 Creatinine 0.7 Glucose 600, Calcium 9.4, Albumin 3.9, TSH 2.18, Urine microalbumin/Urine Creatinine 15, A1C 8.5
Echocardiogram: no left ventricular hypertrophy, normal function, no structural anomalies.
