Differential Diagnosis

Diabetes Mellitus 2 complications: - From the history, the patient mentions that his long time diabetes has not been controlled. The patient admits that he has not adhered to the medication, and this could be the reason why his disease is showing more complications (Lenhe et al, 2014). Other symptoms supporting this diagnosis include renal failure, cardiac manifestations and neurological involvement (Kuehl and Stevens, 2012). Renal failure is indicated by polyuria. High glycated hemoglobin indicates that blood glucose level has been very high for the last three months, a factor that could contribute to DM complications. Lab work should include a renal function test and micro albumin test to rule in renal failure. Creatine kinase, troponin C and lactate dehydrogenase tests are required to investigate the integrity of the heart muscles.

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Chronic depression: - Fatigue is a common symptom of depression. Other presenting signs and symptoms that rule in depression include erectile dysfunction, lack of concentration and low libido. He probably takes beer to reduce depression but it does not appear to help him.

Hypercholesterolemia: - The patient is obese and is suffering from hypertension. High low-lipoprotein cholesterol can be deposited on the walls of blood vessels thus constricting them. A small resultant lumen leads to high blood pressure.

Lab work: - To rule in hypercholesterolemia, a lipid profile is required. The profile includes tests such as low density lipoprotein, high density lipoproteins, triglyceride and total cholesterol. The results will be useful to identify the specific dyslipidemia in the patient.

Lack of enough sleep: - lack of sleep can cause fatigue. The patient takes a lot of coffee which could result in insomnia. Moreover, he suffers from sleep apnea and refuses to put on his CPAP when sleeping. However, since the fatigue started five years ago, lack of sleep could not possible be the cause of it.

Plan of care:

The first thing to do is to make sure is to control the glucose levels in the patient. Injectable insulin will help to achieve to achieve this. Another thing is to alleviate the pain caused by gout. Diclonofenac 100mg taken two times a day will suffice. Allopurinol should be indicated to prevent further accumulation of uric acid in the joints. Depending on the results of the lipid profile test, anti-cholesterol drugs like statin will be useful in regulating cholesterol level in blood. Another thing to do is to advise him on lifestyle. He should quit or reduce alcohol and caffeine intake and start jogging at least for 10 minutes daily to reduce weight (Cornelissen et al, 2013). Weight reduction will help him burn the cholesterol deposited in his blood vessels and eventually overcome hypertension. He should also visit a marriage counselor because of marital problems. He should also get enough sleep and always wear his CPAP machine to overcome sleep apnea. A prostate examination should also be recommended.

References

Lehne, R. A., & Rosenthal, L. (2014). Pharmacology for nursing care. Elsevier Health Sciences.Kuehl, M., & Stevens, M. J. (2012). Cardiovascular autonomic neuropathies as complications of diabetes mellitus. Nature Reviews Endocrinology, 8(7), 405-416.

Pattyn, N., Cornelissen, V. A., Eshghi, S. R. T., & Vanhees, L. (2013). The effect of exercise on the cardiovascular risk factors constituting the metabolic syndrome. Sports medicine, 43(2), 121-133.