DM-II

Hassan M. AlShehri
251040006
Case:
• 56 yr woman
• Polyuria + Polydipsia, -15Kg in one month but have good
appetite
• Complained of: Numbness in her feet + blurred vision.
• Hx of DM in the family

• Physical Examination
• Obese, Pulse 80/m, BP 120/100 mmHg
The rest of CVS, respiratory and gastrointestinal
system was normal.
• Evidence of peripheral neuropathy and hard exudates,
neovascularzation in the eye.
• RBS 450mg/dl

DX
DM-II
Pathophysiology:
• DM is a chronic metabolic disorder with
abnormal regulation of glucose, resulting in
hyperglycemia.

• DM-II: is a multifactorial in nature, with

interaction of environmental (life style,
malnutrition in utero, age and pregnancy)
and genetics factors. It’s characterize by
peripheral insulin resistance, impaired
regulation of hepatic gluconeogenesis and a
relative impairment of beta-cell function.
Problems List:
*High blood glucose
Polyuria, polydipsia, and weight
loss
Numbness in her feet, and blurred
vision

*High blood pressure(stage 2)

Therapeutic Objectives:
Blood sugar control
Blurried vision management
Peripheral neuropathy man
management
Blood pressure control
Management of DM-II
A) Non pharmacologic:
1)Diet (MNT)
2)Exercise
If patient’s glycemic target is not achieved
in 3-4 weeks of MNT and exercise,
pharmacologic therapy is needed.
B) Pharmacologic
1)Oral hypoglycemic
2)Insulin
Management of DM-II(oral
hypoglycemic)
Group Efficac Safety Suitabili Cost Total
y ty
Sulfonylureas 4 2 0 2 8
Biguanides 4 3 5 3 15
Alpha- 1 2 4 1 8
Glucosidase
Inhibitors
Thiazolidinedio 5 1 3 0 9
nes(glitazones)
Meglitinides 4 3 0 1 8
Incretin 4 5 4 0 13
mimetic
Personal drug:
Biguanides: Metformin
HTN Control:
Group Efficacy Safety Suitabili Cost Total
Diuretics 4 2 ty
4 3 13
B- 4 0 3 2 9
blockers
ACEI 4 4 5 2 15
Ca 4 1 3 2 10
channel
blockers
Alpha- 1 0 0 2 3
Blocker
ARB 3 3 3 2 11
 ACEI:

Group Efficacy Safety Suitabili Cost Total

Captopril 5 3 2 ty 1 11

Enalapril 5 4 2 1 12

Lisinopr 5 4 5 1 15
il
Prescription:
Patient Name: Sex: Female
Age: 56 MR: XX
Date: 21/12/2008

Dx: DM-II
Rx:
Metformin 500 mg tablet, P.O. once daily.
Lisinopril 2.5 mg tablet, P.O. once daily for 10 days
5 mg tablet, P.O. once daily.
Referral to ophthalmology.
Referral to neurology.

Doctor: XXX
Signature :XXX
Information:
Eduction about the disease.
Diet: Low in sugar
Exercise.
Stop smoking
Side effects of drugs.
follow up
Thank You