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Headache, palpitations, sweating, and high anxiety
A 43-year-old white man presents for reevaluation of recurrent episodes of palpitations, diaphoresis, headache, and acute anxiety. At the initial visit 2 years ago, the patient complained of episodic palpitations with vague chest pain, which would last for several minutes and then subside. At that time his BP was 120/72 mm Hg. A follow-up stress test had negative results. The patient continued to have paroxysmal spells lasting about 15 minutes of palpitations, diaphoresis, headache, nausea, and apprehensiveness several times a month. Following the gradual resolution of these symptoms, he reported feeling weak and washed-out. At one point he was hospitalized for rapid atrial fibrillation, which converted back to normal sinus rhythm after medical treatment.
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Lactic acidosis associated with metformin use in treatment of type 2 diabetes mellitus
Metformin, an antihyperglycemic, is widely used in the treatment of type 2 diabetes mellitus (DM). A rare, but important complication associated with this drug is the development of lactic acidosis: Overall mortality of lactic acidosis is approximately 50%. Certain subsets of patients taking metformin are at greater risk of developing lactic acidosis.
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New therapies to achieve glycemic control and weight loss in T2DM
Today's management of type 2 diabetes mellitus is supported by an array of therapeutic agents, including new drugs approved in 2005 that can promote weight loss along with glycemic control—pramlintide and exenatide—and an inhaled insulin, which was approved in 2006.
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Consider metabolic syndrome a combination of different conditions
No wonder metabolic syndrome is called syndrome X. Instead of being recognized as a separate disease, it is considered a constellation of many conditions. "The biggest problem is a failure to address the underlying problem—insulin resistance," says Robert Epstein, MD, chief medical officer for Medco Health Solutions in Franklin Lakes, N.J. He calls metabolic syndrome one of the country's top five health problems.
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