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VOLUME 1 ISSUE 1 CASE KM	KM is a 43-year-old woman, who was originally born in India but has lived in the US since she was 19 years old.
CHIEF COMPLAINT KM complains of heel pain, especially bad with first step in morning and gradually improving throughout the day. MEDICAL HISTORY Patient states she last saw a physician 3 years ago. You have no records of past visits at your practice. PHYSICAL EXAMINATION »  Height: 5 ft. 1 in. »  Weight: 185 lbs. »  Slight heel tenderness and discomfort stretching the foot. »  Blood pressure: 135/88 mm Hg (average of two measurements). »  Waist circumference: 39 in. FAMILY HISTORY »  Both parents living. »  Grandparents deceased from heart disease and cancer. »  Mother has type 2 diabetes. SOCIAL HISTORY »  KM does not exercise. »  Rare alcohol use. »  Never smoked. PROBLEMS »  Plantar fasciitis »  Obesity »  Other? TREATMENT »  Heel cushion »  Arch support »  Stretches NAVIGATION »  Q1: What else would you do at this visit? »  Q2: What is KM’s body mass index (BMI) and weight classification? »  Q3: Is KM a candidate for diabetes screening? »  Q4: What blood tests would you order? »  Q5: What do you do now? »  Q6: How would you confirm or rule out a diagnosis of diabetes? »  Q7: What is your diagnosis now? »  Q8: What is your initial treatment plan? »  Q9: What are your initial treatment goals for KM? »  Q10: What other interventions should you suggest at your next visit(s)? When should you see this patient again?	Q: What blood tests would you order? A: I ordered a CBC, a fasting glucose, and a fasting lipid profile. The CBC is a reasonable test in menstruating woman, particularly if hemoglobin has not been checked for years. The third report of the National Cholesterol Education Program (NCEP) on detection, evaluation, and treatment of high blood cholesterol in adults (ATP III) recommends a fasting lipid profile for all adults over the age of 40.3 Although the ADA2 recommends screening either with an FBS or a 2-h glucose following a 74-gram glucose load, I almost always conduct my initial screen with a FBS. I have chosen this screening policy because it logistically easy to implement, inexpensive, and supported by evidence. I do order 2-hour post-glucose load testing if I want a more sensitive test or as a follow-up to an abnormal fasting screen.
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