Age: 27.0
Sex: M
Vaccine: ANTH, SMALL
Symptoms: Nocturia, Nuclear magnetic resonance imaging spinal cord normal, Paraesthesia, Parasite blood test, Parasite stool test negative
Clinical narrative: Patient was in his usual state of excellent health until March 2003. DIABETES: His parents report noting a "change" in SM's health starting in the spring of 2003. Looking back, the first symptom that the service member can recall is polydipsia which began within 1-2 months after his first anthrax vaccine in the spring of 2003. He recalls typically drinking 64 ounces of Gatorade during a 12 hour period. He attributed his increased thirst to the change in climate and being exposed to extreme temperatures. Around the same time, patient recalls voiding multiple times during the day and at least 2 times per night. He thought he was voiding more because he was drinking more fluids. He also began noting blurred vision. By the summer of 2003, he felt extremely fatigued and it was not unusual for him to sleep 14 hours at time when off duty. At the time, he attributed his decreased energy to changes in time zones and his work schedule. By 2004, service member was beginning to lose weight, but it was not really noticeable until December 2004. When he first started losing weight, he attributed the weight loss to only eating 1 meal per day and always being "on the go". His baseline weight was around 140-50 pounds. By December 2004, his clothes were noticeably baggy. By March 2005, his weight was down to 115 pounds. In late March 2005, patient sought evaluation with the Surgeon for ongoing and worsening symptoms. By this time, in addition to polydipsia, polyphagia, blurred vision and weight loss, he also had a 7-10 day history of nausea and vomiting and diarrhea. He could not keep any food down for more than 15 minutes. He was having around 15 watery stools per day. He was afebrile. (Since this initial episode, service member has had brief, similar episodes of GI symptoms over the 4th of July weekend and again in November 2005.) His initial evaluation included a work up to rule out any GI causes for his vomiting and diarrhea. The lab results completed during his initial visits were consistent with diabetes, with blood glucose levels >300. His GI symptoms resolved after insulin was initiated. When he was evaluated at the Internal Medicine Clinic, he was diagnosed with Type 2 diabetes mellitus, but continued on insulin. When his Internist PCS'd, there was question as to whether patient had Type 1 or Type 2 DM, so he was referred to an Endocrinologist, where additional labs were completed; despite his negative antibody testing, he was later diagnosed as T1DM. Patient has no family history of Type 1 or Type 2 diabetes. Prior to being diagnosed with diabetes, he had no history of HTN or dyslipidemia, he was active and was not considered to be overweight. PARESTHESIAS: In the spring of 2005, around the time patient was diagnosed with diabetes, he noted restlessness of his legs and "nerve pulses in different locations...jolt of electricity in legs...lasted a few seconds...feet would occasionally burn". Initially the neuropathies were attributed to his diabetes, but after 3-5 months, his providers wanted to rule out an HNP because sometimes the pain radiated from his waist down both legs. He was referred to Neurology and an HNP was ruled out. Patient reports typical level of intensity for this sensation as a level 7 using an intensity scale of 0 (=normal sensation) and 10 (extremely sensitive). The sensation "waxes and wanes" and its durations is "seconds". The sensation seems to be worse at night after increased activity during that day - "more nerve pulses and burning". Intensity and frequency do not relate to alcohol intake or blood glucose control. Patient has difficulty describing an accompanying symptom of "unsteady feeling"; it is not a dizzy sensation or like he is going to fall, but he is "not able to get control of (his) body...weird sensation"; not tremors or spasms. He was later diagnosed at Clinic w/ lower extremity neuropathy involving small fiber nerves.