Reference no: EM133687028

Question 

Female patient admitted with uncontrolled type 2 diabetes mellitus and pain of the hands, which is of questionable etiology. Rule out vasculitis. The patient is a 63-year-old white female with history of diabetes mellitus for several years and is now type 2. For the last several weeks, her glucose levels have been very high at 290 to 350. We increased her insulin, but she was still running quite high. She has been complaining of pain in her right hand and, to a lesser degree, her left hand. They get red, tingly, and painful; it looks as though she may have vasculitis. Blood pressure 120/64, weight 139 pounds. Patient has some funduscopic arteriosclerotic changes and has been treated for diabetic retinopathy. Lungs are clear. She has some clubbing of the fingers. No cyanosis. Tips of her fingers and thumbs on both hands look red. She is quite tender over the first metacarpal phalangeal joint of the right hand. Doesn't appear to be particularly swollen or feel hot to the touch. She is admitted for vigorous treatment and further evaluation. Urinalysis normal. Complete blood count normal. Sedimentation rate was 77. Fasting sugar on the day after admission was 230; later that day,