DIABETES (T2 DM)

Dr.Kirti Pandhare-Vyavahare
HWC- Shetphal gadhe,PHC-Bhigwan
Taluka-Indapur District-Pune
Designation- Community Health Officer
Email id- drkailasvyavahare@gmail.com
Date-20/06/2019
CHEIF COMPLAINT AND EXAMINATIONS
54 years old male patient
C/O- Frequent micturition
More than 3 times at night -since 2 months
Excessive sweating -since 1 month
Tingling and Numbness
At both lower extremities -since 15 days
Weight loss more than 3kg -in 2 months
BP-150/90 mm Hg Pulse-88/min
 MEDICAL/SURGICAL HISTORY
• Patient is known case of hypertension since 5 years
• h/O Appendicectomy done in September 2014
• No h/O any other medical or surgical illness in past
MEDICATIONS

Relevant past Current

medications medications

T. Stamlo
T.Telma –H 40 mg
5 mg 1 od
1 od
 SOCIAL HISTORY AND FAMILY HISTORY
Education –Bsc .BEed
Occupation –Secondary teacher
Socio-economic class –Middle
Marital status-married
Lifestyle habits-Sedentory work ,Drinks Alcohol
Diet-Vej+Nonvej
Relevant health conditions in the close family members –
Mother is known diabetic,Father and elder brother having
hypertension
 OBSERVATIONS /FINDINGS

Height -168 cm
Weight -72 kg
Pulse-88/min
Bp-150/90 mm Hg
BMI-25.51 kg/m2
CVS-S1S2normal
CNS-Conscious/Oriented
RS-AEBE Clear PA- Soft,Nontender
Local examination –skin lesion ?fungal infection near umbilical
region
 CURRENT LAB TESTS

Test Result Reference Range Comments

Hb 13.2gm/dl 14-18 Borderline

Urine R -puscells 8-10/hpf 1-3/hpf UTI

Urine sugar ++ Nil Present

Serum creatinine 1.10 mg /dl 0.7-1.2 Normal

BSL-R 288mg/dl 70-150 High

Hba1c 10.2 4.2 -6.0 High

LAB TESTS AND IMAGING RESULT
IMAGES/SCREENSHOTS
INVESTIGATIONS ADVISED
• Lipid profile-to rule out hyperlipidemia
• Thyroid function test-tube rule out hypo or hyperthyroidism
• Usg abdomen—to rule out renal abnormality
• Ophthalmic opinion fundoscopy for eye check up
DIAGNOSIS AND TREATMENT PLAN

• Differential diagnosis-
• Hyperglycemia with hyperthyroidism
• Diabetes Melitis Type -2
• Stress related Hyperglycemia
• Final diagnosis –
• Diabetes Melitis Type 2
Treatment Plan
• Lifestyle management
• Avoid alcohol consumption
• Exercise regularly for 150 min per week
• Loose weight
• Avoid sweets and sugar
• Foot care
• Counselling about disease
• Yoga and Pranayam
Drug Therapy
• Tab –Azulix MF 1 1 BD
• Tab -Telma H 1 OD
• Tab -Gris ODT 1 OD × 7 Days
• Orkid 4 cream for local application
QUESTIONS FOR THE HUB TEAM
• 1- Which investigation should be preferably done to monitor blood
glucose level, BSL-F,PP OR Hba1c?

• 2-What are the guidelines for the treatment of Diabetes with

comorbid conditions like Hypertension and Cardiac disease?