50 year old Man with uncontrolled DM 2

 A 50 year old man who's a resident of nakrekal,labourer by occupation came to the opd to get admitted under de-addiction


HOPI : 
Patient was appareantly asymptomatic 4 years back ,then he developed 

•   Burning type of pain in the right and left hypochondrium,3 to 4 episodes for which he went to a local hospital and got medications(He's a chronic alcoholic since 30 years), and the symptoms subsided,his last episode was the day after he got admitted here and was given pantop iv and the symptoms subsided. 

• H/o weight loss approximately 20 kgs since 15 months

•   1 year back he was found to have high Sugars at a government camp at his place used OHA's for 4 months 

•   Then he developed complaints of Generalized weakness, polydypsia, poly urea for which he visited a private hospital at Nakrekal found to high sugars (Uncontrolled DM 2 ) He was on insulin(10 U morning,5U in the night) since then (took Insulin Irregularly) .
• Complaints of Diminution of vision since 8 months and double vision in the mornings since 7 months

• H/o light trauma 3 month back then he developed  bubble like lesions along the right 3-4ICS , associated with pain and itching for which he went to a local hospital and got some medications and pain and itching decreased in intensity ,later Complaints of shooting type of pain along the dermatome (on right side of 3-4 ICS,intermittent in nature,occuring one or twice for about 5 to 10 minutes once in 3days since 29/7/22 ,associated with itching and tingling sensation

• H/o Trauma (with mild skin abrations over the ankles and bony prominences ) 15 days back,then he developed itching over the wounds

Came to the opd and got admitted for de-addiction and was sent to GM for uncontrolled DM 2(550mg/dl)

• Complains of body pains since 3 days for which he was given tramadol 

• Vomitings on 1/8/22 morning 
2 episodes ,projectile type with food particles as content(  early in the morning& after consuming milk) for which he's given medication and the symptoms subsided

• Burning type of pain in the right and left hypochondrium and epigastric regions since 2/8/22 on and off  for 1to 2 hours in a day 

• Fever since 3/8/22 which is low grade, intermittent in nature, not associated with chills and rigor and got relived on medication

PAST HISTORY : 
K/c/o DM 2 since 1 year
Not a K/c/o Hypertension ,asthma ,CAD, epilepsy, hypothyroidism

PRESENT HISTORY
Daily routine :
He was a labourer by occupation.

Wakes up at 6 AM
Does household work
Breakfast at 9 AM
Goes to work
Lunch at 2 PM
Returns home 6 PM
Dinner at 8 PM
Sleeps at 9 PM
" Takes Alcohol either in the morning at 10 am or 7 pm in the evening"
PERSONAL HISTORY
Diet: mixed
Appetite: normal
Bowel and bladder movements :Normal
Sleep: adequate
No known allergies
Addictions : chronic alcholic since 30 years 

FAMILY HISTORY 
  No significant family history

TREATMENT HISTORY
   Was on glimiperide for 2 months after getting diagnosed with DM, and stopped using after that, later after 2 months He was on insulin(2.5IU) ,but was not taking insulin regularly


GENERAL EXAMINATION
  •Patient is examined in a well lit room after obtaining consent
•Patient is conscious, coherent, cooperative.
 Well built and well nourished.
•Mild Pallor 
•Icterus,clubbing, cyanosis, koilonychia, edema are absent




•VITALS 

Temp- Afebrile 

Bp-90/60 mm hg

PR- 82bpm

RR-18CPM

Spo2- 96% on RA

GRBS : 550mg/dl



              SYSTEMIC EXAMINATION 


RS- bilateral air entry present 


CVS : S1, S2 + no murmurs 


P/A- soft and non tender
      
bowel sounds present 

CNS : No focal neurological defeicit 
HMF intact 
Power in B/L upper and lower limb Is 5
Reflexes are present with B/L plantars and flexors

INVESTIGATIONS : 

                          *Fever chart 

                    *X-Ray Chest PA view


                             *HbA1c
*Liver Function Test

*Blood Urea

*Serum Creatinine

*Serum Potassium

*CUE


*CBP


                                       *ECG


*USG Report





***Previous reports on 25/7/22












*PROVISIONAL DIAGNOSIS : 

      Chronic Alcoholism with Uncontrolled Diabetes Milletus 2 with Post Herpetic Neuralgia


*TREATMENT :



√T.THIAMINE PO/OD
√ T. GLIMI - M₁ PO/TIC
√ 70 PROFILE GRBS MONITORING
√ Pre Breakfast , 2hrs After Breakefast
√ Pre Lunch, 2hrs after LunchLunch
√ Pre dinner, 2hrs after dinner
√ 2 AM in the morning
√ INJ HAI 6 Units S/C
√ Pregaba -m 75mg/PO/ HS 
√ Paracetmol 650mg since 3/8/22
√ T.Ultracet 1/2 tab/PO/QID
√ T.Optineuron amp in 100ml NS/IV/OD
√T.Pantop 40mg /PO/OD

27/7/22

{  11PM -- 550 mg/dl -- 6 Units HAI given
    2 AM  -- 247 mg/dl
    4 AM  -- 47 mg/dl -- 25%D given            }


28/7/22 

{8am - 100 -  TAB.Glimi 2.5 mg ,Metformin 1gm
10am - 85 mg/dl - 2 idly
2pm - Hi - 6U HAI given
4pm - 474
7pm - High - Glimi 2.5 mg,Metformin 2 gm
10pm - 532 mg/dl }




29/7/22

{   8am - 312 - Glimi 2.5mg ,metformin 1gm
 10am - 461
1 pm - 397 - 4U HAI 
4pm - 416
7pm - Hi -   4U HAI ,4U NPH
10pm -  404                                                 }

 


30/07/22

 {   2 am - 355     
    8 am - 466  - Glimi 2.5 mg,metformin 0.5mg
   10pm -  Hi - Glimiperide 4 mg,metformin 1gm
    12pm - 321 -HAI 4units SC 
    3pm - 325
     7pm - 466 - Tab.Glimi 2.5mg 
                      Tab metformin 1g/dl                  }
  
 
  31/07/22

 { 12am- Hi - HAI 4U ,NPH 5U
   4am - 177
   8am - 239
   10pm - 348 Glimiperide 4mg,metformin 1gm
   1am - 385
   2pm- 324
   4pm- 528 Glimi 4mg metformin 1gm
   10pm-345                                                  }
   
 01/08/22

{ 2am- Hi Glimi 4mg metformin 1gm
  8am-288 
  10am-352 
  Ondansetron 4mg given 2episodes of                 vomitings
  1pm-200 
  4pm-394
  8pm-338 - Glimi 4mg metformin 1gm
  11pm -333                                                   }
 
02/8/22 

{     2am -  336
      8am-155         
    Glimiperide 4 mg,metformin 1gm
     
      12 pm -318                                           
      2 pm -281
     4 pm - 470
     8 pm - 391
     10 pm  477     Glimi 4mg,metformin1mg     }


3/8/22


{        2am  - 362
         8 am - 135
        Glimiperide 4mg,metformin 1mg
         12pm  - 300
          8pm - 532 - Glimi 4mg ,metformin 1mg 
         10pm - 411                                                  }

4/8/22

{      2am - 320  
        8am - 176 
       Glimiperide 4mg,metformin 1mg
        2 idly
        11am 528
        1 30 pm - 368
        3 pm - 388     
        4pm - 363            
        8pm - 515
        Glimiperide 4mg,metformin1mg
        10:30pm - 563                                      }

5/8/22

{        2am - 374
          8am - 194  
Glimiperide 4mg,metformin 1mg
          10am - 328
          1pm - 181
          2pm - 363
          8pm - 384
Glimiperide 4mg,metformin 1mg
          10:30pm - 560                              }

6/8/22

  {       2pm - 370
          8am - 342
          10am - 247
   Glimiperide 4mg ,metformin 1 
           1pm- 334
          10pm - 526
Glimi 4mg,metformin 1mg                     }

7/8/22

{        2am - 357
         8am - 249
Glimi 4mg , metformin 1mg
         10pm - 360    
Glimi 4mg , metformin 1mg                                }

8/8/22

{      2am - 325
       8am - 139                                            }

Advice at Discharge

√ TAB GLIMIPERIDE 4MG PO BD
   BEFORE FOOD [MORNING AND NIGHT]
√ TAB METFORMIN 1000MG PO BD
    AFTER FOOD [MORNING AND NIGHT]
√ TAB PREGABALINE M 75MG PO H/S FOR 9        DAYS
√  TAB MVT PO OD FOR 15 DAYS
√  TAB PCM,650MG PO TID FOR 5 DAYS
√  TAB PANTOP 40MG PO OD FOR 5 DAYS
√  TAB ULTRACET 1/2 TAB PO QID FOR 3 DAYS
√  TAB BENFOTHIAMINE PO BD FOR 15 DAYS

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