1

A CASE STUDY ON
DIABETES MELLITUS
LIDA ELIZA JOSEPH
REG NO :140090850
 2

SUBJECTIVE DATA
PATIENT DEMOGRAPHICS 3
PATIENT X

MRD NO 324109

AGE 20

SEX FEMALE

SPECIALITY ENDOCRINOLOGY

DOA 19/11/2011

DOD 21/11/2011
REASON FOR ADMISSION 4

2 days h/o dyspnoea & nausea.

 Few episodes of vomiting.
2 weeks h/o burning sensation in feet.
 Her blood sugar were persistently above
400mg/dl
PAST MEDICAL HISTORY 5

H/O previous admission here for

 Diabetic Ketoacidosis
 Glycemic control
MEDICATION HISTORY 6
 Inj.Human Insulin – R s/s
 Inj.Human Insulin – N s/s
 Tab.Pregabalin 75mg OD
 Cap.Becosules Z OD
FAMILY HISTORY:NIL

SOCIAL HISTORY: NIL

ALLERGY: NIL
 7

OBJECTIVE DATA
PHYSICAL EXAMINATION 8
PROFILES
VITALS

TESTS 20/11/11 REFERENCE

RANGE

Pulse Rate 84 beats/min 60-100 beats/min

Respiratory Rate 20 breaths/min 12-15 breaths/min

Blood Pressure 110/70mmhg 120/80mmhg

 HAEMOGRAM 9
TESTS 20/11/2011 REFERENCE RANGE
PPBS 400mg/dl 100-140mg/dl
RBS 250mg/dl 80-120mg/dl
MCH 29.0pg/cell 27-31.2pg/cell
MONO 5.38% 0-7%
EOS 2.36% 0.7%
BASO 0.586% 0-2%
MCV 84.4% 80-97%
RBC Count 4.17millioncell/ml 4.04-
6.13millioncell/ml

Hb 12.1gm/dl 12.2-18gm/dl
PLT Count 380.0k/vl 150-450k/vl
RENAL FUNCTION TEST 10

TEST 20/11/2011 REFERENCE RANGE

Creatinine 0.79 0.5-1.4 mg/dl

 11
LABORATORY PROFILES
URINE TEST

INVESTIGATION 20/11/2011 REFERENCE

RANGE
GLUCOSE 4+ Negative
COLOUR Pale yellow Straw
MICROSCOPY RBCs , EPI(++)
PUS cells(++)
LEUCOCYTES 1+ Negative
PROTEIN Negative Negative
KETONE 1+ Negative
 12

ASSESSMENT
DIAGNOSIS 13

 TYPE
1Diabetes Mellitus with
Ketosis
DISEASE DESCRIPTION 14

Diabetes Mellitus is the most common of endocrine

disorders.It is a chronic condition,characterised
by hyperglycaemia and due to impaired insulin
secretion with or without insulin resistance.
Type 1 Diabetes(Insulin Dependant Diabetes Mellitus
or IDDM) is a disease that causes destruction of
the insulin-producing pancreatic beta cells,the
development of which is is either autoimmune T-
cell mediated destruction(type 1A) or
idiopathic(type 1B).
PATHOPHYSIOLOGY 15

In type 1 diabetes there is an acute deficiency

of insulin that leads to unrestrained hepatic
glycogenolysis and gluconeogenesis with a
consequent increase in hepatic glucose
output. Glucose uptake is decreased in
insulin sensitive tissues, hence hyper
glycaemia ensures.
Either as a result of the metabolic
disturbence itself or secondary to infection or
other acute illness, there is increased
secretion of the counter regulatory hormones
glucagon, cortisol, catecholamine and
growth hormone. All of these will increase
hepatic glucose production
Signs and Symptoms 16
 Type 1 diabetes are more severe and faster in
onset. Common symptoms include
 polyuria
 nocturia
 polydipsia.
 These are all a consequence of osmotic diuresis
secondary to hyperglycaemia. These are
symptoms are frequently accompanied by
 fatigue and
 marked weight loss.
 Blurred vision
 experience a higher infection rate especially
candida, UTI due to increased circulating glucose
levels
Ketoacidosis 17
It is a life threatening complication in patients
with Type1 D.M. It occurs because absence of
insulin causes extreme hyperglycaemia.
The normal restraining effect of insulin is
removed. Fatty acid release occurs and keto
acids such as acetone ,aceto acetate.
Betahydroxy butyrate enters into circulation.
Dizziness
Weakness
Pottassium loss
Increases dehydration & hyperosmolarity
Kussmaul respiration
Patient breath may have the fruity odour of
acetone
 18

PLAN
MEDICATION CHART
19
SL. Brand Generic name Dosing frequency Rout Date
No name e 20.11 21.11

1. Inj.Human Human insulin 12-12-10 units S/C √ √

insulin-R

2. Inj.Human Isophane insulin 16-0-12 S/C √ √

insulin-N units

3. Tab. Amoxicillin + 625mg tid P/O √ √

Augmentin Clavulanic acid
4. Tab. Pregabalin 75mg OD P/O √ √
Pregabalin
5. Cap. VitaminB + zinc 1 capsule OD P/O √ √
Becosules Z
6. Tab.PanD pantoprazole 40mg OD P/O √ √
+Domipiridone
DISCHARGE MEDICATION 20

Inj.Human insulin-R 12-12-10 units 3 times a day

Inj.Human insulin N 16-0-12 units 2 times a day

Tab.Augmentin 625 mg 1-1-1

Tab.pregabalin 75 mg 0-0-1

Tab.pan D 40 mg 1-0-0

Cap.Becosules Z 1 tablet 1-0-0

PATIENT COUNSELLING 21

Counseling regarding sign and symptoms

 If there is excessive thirst & tendency for
frequent urination, immediately check blood
glucose level
 Always take care of hypoglycaemic symptoms
like fainting,lethergy while doing exercise,
taking insulin or antidiabetic drugs
Diet
 Eat regular meals based on starchy food such
as cereals, choose fiber varieties
 Cut down saturated fat containing foods
Cut down the sugar & sugary foods
Select carbohydrate which has a lower glycaemic index 22
Exercise
Anerobic exercise should be avoided
Avoid physical exercise if glucose level is 250mg/dl & ketosis is
present
Monitor blood glucose level before and after physical activity
Blood glucose level is reasonably controlled
 cvs should be stable
Don’t exercise during peak insulin time around 3 & 7 hrs.
Insulin therapy
Do not inject insulin in the same location as it can cause
lipohypertrophy
Carry a diabetic ID card
Carry candies or sugars
Urine test blood test 23
Urine test should be done for
ketone & glucose
Home blood glucose monitering
should be carry out
Diabetic self care
Foot care
Neuropathy, peripheral vascular
disease causes lower extremity
complications
 24

Eye care : An yearly

dilated eye exam is
recommended
CONCLUSION 25

REFERENCE
 Clinical pharmacy by Roger walker pg no:640-650
 CIMS july-oct 2013
 Essentials of pharmacology by K.D Tripathi pg no:250
26