case on uncontrolled DM

50 Yr Male with Uncontrolled Sugars

06 august 2022

This is online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs.This e-log also reflects patients centered learning portfolio.

Case in brief
A 50yr old male ,farmer by occupation came to opd ,for deaddiction 
Chief complaints
• Generalized weakness since 15days 
• Polydipsia
• Polyuria 

History of present illness
• Patient was apparently asymptomatic 1yr back then he was diagnosed to have diabetes at a government camp.
• So then he was given oral antigycemic drugs ,he used it for 2months and stopped it.
• So, he developed generalized weakness, polydipsia, polyuria.
• Then he visited a private hospital at nakrekal,then was found to have high sugar levels ,since then he was started with insulin,but he was on a irregular medication. 

History of past illness
• He was a k/c/o of type 2 diabetes 1year back.
• He was not a k/c/o hypertension, asthma,CAD, epilepsy

Treatment history
• He was on diabetic medication
• No history of use of any other medication 

Family history
• There is no significant family history 

Personal history
• Mixed diet 
• Normal appetite
• Normal bowel movements
• No known allergies
• Adequate sleep
• Habits-
• chronic alcoholic -180ml/day since 30yrs
     Tobacco smoking(beedi) since 30yrs 1pack/day
• Daily routine- He generally wakes up at 6:00am in the morning and at 7:00am he'll have his breakfast(rice) .And the goes for farming ,and then he'll have his lunch at 2:00pm and returns from farming at 6:00 in the evening and drinks alcohol and goes to bed around 9:00pm. 

GENERAL EXAMINATION 

on Examination,
patient is conscious,coherent,co - operative and well Oriented to time,place and person. 

There are no signs of 

Icterus,cyanosis,clubbing,Lymphadenopathy and oedema 


There is presence of mild pallor.  
VITALS
Temperature: 98°F
PR: 82bpm
BP:90/60
RR:18/min
RBS-541mg/dl 

Sytemic examination 

C VS:
No thrills 

S1 and S2 + 

NO murmurs 

Respiratory system 

NO Dyspnoea 

NOWheeze 

Trachea is centrally located 

Abdomen 

soft and non tender 

NO palpable Mass 

Liver and Spleen are not palpable 

CNS

NAD 

Investigations:
  

Ultra sound:
Fatty infilteration of liver 

Mild hepatomegaly

Coarse texture of liver 


DIAGNOSIS 

Uncontrolled Diabetes 
Zoster lesions

TREATMENT
27/7/22
• Tab.BENFOTIAMINE PO/OD
• TAB.GLIMI -M1 PO/OD
• INJ. HAI 6units S.C
• GRBS monitoring 

28/7/22 

• Tab.BENFOTIAMINE PO/OD
• TAB.GLIMI -M1 PO/OD
• INJ. HAI 6units S.C
• GRBS monitoring

29/7/22
.Tab. BENFOTIAMINE PO/BD 
 Tab. GLIMI -M1 PO/BD 
Tab PREGABA- M 75mg 

Vitals :
29/07/22
BP 110/70mmHg
PR 68/min 
3pm - 325mg/dl
  7pm - 466 - Tab.Glimi 2.5mg 
                      Tab metformin 1g/dl
4am - 177mg/dl

  31/07/22
  8am - 239 mg/dl
  1am - 348mg/dl
   2pm- 324mg/dl
   4pm-528 mg/dl Glimi 4mg metformin 1g/dl
   10pm-345mg/dl
   
  01/08/22
  Glimi 4mg metformin 1g/dl
 8am-288 mg/dl
 10am-352 mg/dl
 1pm-200 mg/dl
 4pm-394mg/dl
 8pm-338 - Glimi 4mg metformin 1g/dl
 11pm-333mg/dl
 2am-336mg/dl
 
02/8/22 
Glimi 4mg metformin 1g/dl
 8am-155mg/dl
 11:30am -318mg/dl
 5:00pm-394mg/dl
 8:00pm- 338mg/dl
 10:30pm-477mg/dl
 2:00am-362mg/dl

 03/08/22
 8:00am-135mg/dl
 12pm - 300mg/dl
  8pm - 537mg/dl
  10pm - 411mg/dl
  2am - 320mg/dl
  
04/08/22
2am -320mg/dl
 8am - 176mg/dl

05/08/22
11am-528mg/dl
1pm-368mg/dl
3pm-388mg/dl
10:30pm-119mg/dl
2am-120mg/dl

06/08/22
2am-270mg/dl
8am-340mg/dl
11am-270mg/dl

 

Comments

Post a Comment

Popular posts from this blog

39 year old with ascites

Image
December 07, 2023 This is a case of a 39 year old bus driver who is a resident of West Bengal. CHIEF COMPLAINT: Abdominal distension since 2 months. Swelling in the leg since 2 months. Decreased appetite since 2 months. Decreased urine output since 1 month.  HISTORY OF PRESENT ILLNESS- Patient was apparently asymptomatic 2 months ago then he developed abdominal distension which was insidious in onset and gradually progressive, associated with decreased appetite. Later he developed bilateral pedal edema extending upto the knees which is of pitting type. After a month his urine output got decreased still he continued his work as a bus driver. His relatives started noticing that his abdomen is getting distended and his appetite is decreased. They suggested him to see a doctor following which he took a homeopathic treatment in West Bengal But there was no improvement. He also took some ayurvedic medication but nothing seemed to work out. Then he came to our hospital with complaints of ...
Read more

prefinal osce and learning points

Image
OSCE AND LEARNING POINTS PREFINAL PRACTICAL EXAMS NAME : LEKHANA ROLL NO: 64 DATE: 8 DECEMBER,2023 Blog link: 1) AUTOIMMUNE HEPATITIS: -Autoimmune hepatitis is when the body’s infection-fighting system (immune system) attacks your liver cells. -It is a long-term chronic liver disease that causes inflammation and liver damage. Experts don’t know what causes it, but it is more likely to appear in people living with other autoimmune conditions. Certain medications can also trigger autoimmune hepatitis. -It affects more women than men. -It can lead to scarring of the liver (cirrhosis) and liver failure 2)CIRRHOGENIC DOSE OF ALCOHOL: - Time to develop Alcoholic liver disease is equal to amount of alcohol consumed -Men:60-80gm /day for 10years -Women:20-40gm /day for 10 years - Alcoholic Cirrhosis,develops only in 10-20% of those who are chronically heavy drinkers. 3) VIRAL HEPATITIS LEADING TO LIVER CIRRHOSIS: - Heaptitis A has low chances of leading to long term complications like Cirrhosi...
Read more

70 yr old female with seizures and slurred speech 30/08/22

Image
A 70 yr old female with seizures and slurred speech  Note - This is an a online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input. This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan. Case -  A 70 year old female came to the OPD with the chief complaint of sudden involuntary movements since 5 pm yesterday.  History of presenti...
Read more