Patient Management: Frequent Urination and Increased Hunger in a 55-year-old Man
To help PAs stay sharp for the certification exam, this new feature of DermPerspectives tests your knowledge of medical and/or surgical subjects.

A55-year-old African-American male with a history of moderate high blood pressure for four years presents to his general practice PA for an annual check-up. The patient has gained 12 lbs. over the past year, stating that much of the weight gain was in the past three to four months. He reports that he works out for about 30 minutes three times a week, but he “always feels hungry.”

He asks his PA about prostate health, noting that he finds himself urinating frequently. He also notes that he is scheduled to see an ophthalmologist because his “reading glasses” are no longer sufficient; he occasionally experiences blurred vision. Upon further questioning, he indicates that blurriness is intermittent and not just evident when he tries to read small print or look at the computer screen.

The PA questions the patient and determines that his mother, now deceased, always said she was “pre-diabetic.” The PA orders a glucose tolerance test and blood glucose test. Why? What other steps are indicated?

Answer
This patient presents with two of the three classic symptoms (“Three Ps”) of diabetes:

Polyuria (frequent urination). This patient mistakenly attributes frequent urination to possibly enlarged prostate.

Polydipsia (increased thirst).

Polyphagia (increased hunger). The patient mentions feeling hungry and has recently gained weight.

He also complains of blurred vision, which is a common presenting symptom of diabetes. People with diabetes are at risk for retinopathy. They are 40 percent more likely to suffer from glaucoma than people without diabetes and are 60 percent more likely to develop cataracts. Risk for retinopathy increases as the duration of disease increases; Nonproliferative retinopathy is more common than proliferative.