Testing of hemoglobin A 1C (HbA 1C ) levels has become widespread in the management of patients with diabetes mellitus. Since the 1980s, it has proven to be an invaluable tool correlating with a patient's average blood glucose levels as well as with their disease morbidity. Clinicians often base treatment decisions and make adjustments depending on a patient's HbA 1C Case PresentationMrs. J, a 43-year-old woman, presented to the family medicine clinic for her annual wellness examination. She had no active complaints and was feeling fine. Her past medical history was significant for gestational diabetes, hyperlipidemia, fatty liver, hereditary spherocytosis, and borderline diabetes. She reported a 30 pack-year smoking history, and her medications included folic acid, a daily multivitamin, and fenofibrate. At the time of evaluation, her physical examination was unremarkable. Review of her laboratory data showed a fasting glucose of 187 mg/dL, a hemoglobin of 10.6 g/dL, a hematocrit of 0.273, a total bilirubin of 2.4 mg/dL, and a HbA 1C of 0.048. The remainder of the results from her laboratory examinations was not clinically significant. Further review of her medical record revealed that her low hemoglobin and hematocrit as well as her elevated bilirubin were stable and consistent with her diagnosis of hereditary spherocytosis. Of particular note, her fasting glucose was well over the diagnostic cutoff for diabetes mellitus (Table 1). Further review of her chart showed that Mrs. J had multiple fasting glucose values in the diabetic range dating back to 4 years before her current evaluation but was never diagnosed with diabetes mellitus. Over the last 2 years, her fasting glucose had ranged from 170 to 192 mg/dL (Table 2). Her HbA 1C over this same period was consistently less than 0.05. Given her persistently elevated fasting glucose levels, Mrs. J was diagnosed with diabetes mellitus despite her This article was externally peer reviewed.

Dermatologic illnesses have historically been a significant source of morbidity and resource utilization in fielded military forces. The impact of cutaneous diseases during U.S. military conflicts is reviewed, and recent data from Craig Joint Theater Hospital at Bagram Air Field in Afghanistan are presented, confirming previous experience. A discussion of the difficulties of diagnosing and treating dermatologic conditions for deployed primary care providers is provided, including recommendations to improve patient care and military unit readiness.

Ours is the first documented case of a diffuse urticarial reaction following laser tattoo removal treatments that shows a strong association to titanium dioxide within the tattoo pigment. Herein, we describe a novel surgical approach to treat recalcitrant generalized allergic reaction to tattoo pigment.

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