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Phyllis' frequent urinations (polyuria) probably are causing her thirst and other symptoms. These symptoms and the fact that her mother and uncle were diabetics suggested that this woman might have diabetes melli-tus. Indeed, polyuria, polyphagia (frequent eating), and polydipsia (frequent drinking)— the "three P's"—are cardinal symptoms of diabetes mellitus. The fasting hyperglycemia (blood glucose concentration of 150 mg/dl) confirmed the diagnosis of diabetes mellitus. This abnormally high fasting blood glucose is too low to result in glycosuria. She could have glycosuria after meals, however, which

Appendix A

would be responsible for her polyuria. The oral glucose tolerance test further confirmed the diagnosis of diabetes mellitus, and the observations that this condition appeared to have begun in middle age and that it was not accompanied by ketosis and ketonuria suggested that it was type 2 diabetes mellitus. This being the case, she could increase her tissue sensitivity to insulin by diet and exercise. If this failed, she could probably control her symptoms with drugs that increase the tissue sensitivity to the effects of insulin.

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