Mr. Luigi De Luca, a 57-year-old male, was admitted on 1st April following a pre-diabetic episode characterized by episodes of fatigue, polyuria, and increased thirst. Recent routine blood tests showed elevated fasting blood glucose and HbA1c levels that required further investigation.

When Mr De Luca arrived in the morning we recorded a fasting blood glucose level at 180 mg/dL. His HbA1c level was 7.8%. He seemed to be dehydrated, so that he immediately was sent to the ward for a full breakfast and fluid substitution.

Mr. Luigi has a family history of diabetes (type 2, mother and maternal grandmother).

Vital signs	1st April	10th April
Body weight	109 kg	108 kg
Body height	177 cm
Blood Pressure	155 / 95 mmHg	150 / 90 mmHg

The patient smokes "a few" cigarettes per day.

During the hospital stay from 1 to 10 April, Mr. De Luca underwent a series of diagnostic tests, consultations and initial treatment.

Throughout his hospital stay, Mr. De Luca was monitored closely. His blood sugar levels improved modestly with the introduction of Metformin, and no acute complications were observed.

Blood Glucose Monitoring Regular monitoring of fasting blood glucose levels and random blood glucose levels. Fasting glucose levels consistently ranged between 140-180 mg/dL.

Date	Fasting glucose [Moles/volume] in Blood	Range
1 April 2025	180 mg/dL	70 to 99 mg/dL
2 April 2025	140 mg/dL	70 to 99 mg/dL
3 April 2025	150 mg/dL	70 to 99 mg/dL
5 April 2025	140 mg/dL	70 to 99 mg/dL

HbA1c Test: An HbA1c level of 7.2%, confirming the diagnosis of Type 2 Diabetes Mellitus.

Date	Hemoglobin A1c [Mass/volume] in Blood	Range
1 April 2025	7.2%	< 5.7%

Oral Glucose Tolerance Test (OGTT): This test further confirmed impaired glucose tolerance.

Date	Glucose [Mass/volume] in Serum or Plasma --1 hour post dose glucose	Range
2 April 2025	180 mg/dL	70 to 99 mg/dL

Lifestyle Consultation: Mr. De Luca met with a dietitian to discuss necessary changes in his diet, focusing on a low glycemic index diet and the need to monitor carbohydrate intake. He was also advised to engage in regular physical activity.

Diabetes Education: Mr. De Luca attended educational sessions on diabetes management, including the importance of regular blood sugar monitoring, recognizing hypoglycemia and hyperglycemia symptoms, and foot care.

Starting Pharmacotherapy with Metformin.

Metformin 500 mg twice daily was started as the first-line treatment to help control blood glucose levels.

Medication administrations	Dose/Frequency	SNOMED
Metformin, oral tbl	500 mg, twice / day	765507008
Multivitamines	daily

Follow-up	Activity	SNOMED
Endocrinology Clinic	Follow-up appointment in 2 weeks to assess response to treatment	306118006 Referral to endocrinology service (procedure)
Dietitian Consultation	Appointment in 1 month for further dietary planning	103699006 Referral to dietitian (procedure)
Routine Blood tests	Repeat HbA1c in 3 months	43396009 Hemoglobin A1c measurement (procedure)

Discharge Diagnoses	Codes
Type 2 Diabetes Mellitus – Newly diagnosed.	Type 2 diabetes mellitus E11 (ICD-10) Diabetes mellitus type 2 (disorder) 44054006 (SNOMED)

Instructions at Discharge to Mr. De Luca

• Continue home glucose monitoring and to maintain a log for review at follow-up appointments.
• Continue with the prescribed medication and lifestyle changes.
• Monitor blood sugar levels at home regularly.
• Adhere to the diabetic diet plan.
• Stay physically active, with at least 30 minutes of moderate exercise most days of the week.
• Return to the emergency department for any signs of hyperglycemia (e.g., excessive thirst, urination, confusion) or hypoglycemia (e.g., sweating, shakiness, confusion).