Diabetes mellitus A Case Study

 

Mahesh Babasaheb Kolap¹, Nandini Maruti Bhise², Nisha Vasant Poojary³, Rajesh Keshav Bhadke⁴

Dr. Bapuji Salunkhe Institute of Pharmacy, Miraj, Maharashtra 4164116

 

ABSTRACT:

Diabetes mellitus is a group of metabolic disorders that leads to High blood glucose levels, resulting in excessive urination, increased thirst, blurred vision, tingling, sweating and many other systems. Acute conditions include diabetic ketoacidosis and nonketotic hyperosmolar coma while long term condition results in stroke, kidney failure, and cardiovascular disease.

 

 

 

INTRODUCTION:

Diabetes mellitus is a metabolic disturbance characterized by hyperglycaemia and relative lack, or complete absence of insulin¹. It is disease which by virtue of its complications may affect all organ systems in the body.

 

Prevention, timely diagnosis and treatment of important in patients with diabetes mellitus. Many of the complications associated with diabetes, such as nephropathy, retinopathy, neuropathy, cardiovascular disease, stroke, and death, can be delayed prevent with appropriate treatment of elevated blood pressure, lipids and blood glucose^2,3.

1)   Type 1 diabetes: cell producing insulin are destroyed Commonly detected before the age of 30years

2)   Type 2| diabetes: Blood glucose increases due to lack of insulin production less insulin action (resistance). Commonly detected after the age of 40.

 

A body usually is able to keep glucose concentration stable. The normal fasting blood sugar is usually between 3.5-6.7mmol/I.

 

After a meal it would rarely exceed 8mmol/Normally there is no glucose in urine since the normal threshold above which glucose would appear in urine would be 10mmI/I. Below a concentration of 10mmoI/I. the kidneys reabsorb glucose back into the blood stream and glucose does not appear in the urine unless the blood concentration of glucose in high^4.

 

When the amount of glucose in the blood increases, e.g., after a meal, it triggers the release of the hormone insulin from the pancreas. For many years, scientists have been searching for clues in our genetic makeup that may explain why some people are more likely to get diabetes than others are. "The Genetic Landscape of Diabetes" introduces some of the genes that have been suggested to play a role in the development of diabetes.

 

Case presentation:

Mr. Mahesh Babasaheb Kolap from Sangli Maharashtra visited Service hospital sangli (Swad Diabetic care center Dr. Kapil Patil) with the complaints of excessive urination, sudden weight loss (10%), blurred vision, increased thirst, fatigue and excessive sweating, He was experiencing theses form last six month.

 

Past Medical History:

Patient was not suffering from Hypertension.and any other disease 

Past Medication History:

There is no past medication history

 

General Examination:

Weight: 83kg

Height: 6 foot

BMI: 23055.6kg /M2

Physical activity: daily work routine in college.

 

Special investigation:

According to reported symptoms, patient's blood glucose level was monitored. At the time patients random blood glucose level was 337 mg/dl which was beyond the normal range of the random blood glucose level (>140mg/dl). Patients was also said to monitor his fasting glucose level that 280 mg/dl which was also beyond the normal range (70-100mg/dl). Hba1c range 13.0% Dr was suggested to blood and routine urine Check-up, and also liver function test and Electro cardio gram

 

 

1 Blood test                                                                              2 Hba1c

 

 

3 LFT                                                                                         4 Urine Test

 

 

5 ECG

 

Treatment:

One month treatment Tab Glimepiride 2 mg+ Metformin 500mg BID, Tab Vildagliptin 50mg once in day, Tab Pregabalin 75mg+ Nortriptyline 10mg once in days, Cap Methyl cobalamin 1500mcg once in day, Inj Methyl cobalamin I.M once a week

 

Intervention:

Drug should be taken about 5-10 minutes before the meal   Instead of eating a lot at 3 meals, divide total intake in 5 meals. Drug interactions was checked, no interaction was present b/w all drugs

 

Suggest patient to check HbA1C level after about every 3rd month.

 

Care plan:

Proper diet ------low suger intake

Exercise and walk to reduce body weight

High fiber diet less intake of fast and carbohydrates

 

Outcome:

Patient used the suggested medicine after using medicine One month  treatment Tab Glimepiride 2mg+ Metformin 500mg BID, Tab Vildagliptin 50mg once in day, Tab Pregabalin 75mg+ Nortriptyline 10mg once in days, Cap Methyl cobalamin 1500mcg once in day, Inj Methyl cobalamin I.M once a week  the blood glucose level of the patient was monitored after one month

 

Fasting = 346mg/dl

After meal = 540 mg/dl

 

After next follow up check-up Dr. suggested to Mr Mahesh Kolap to taken a insulin 14 unit once in day.

 

Patient was advised to visit hospital if he suffers any side effect in future or, if his symptoms not properly treated.

 

Complication or adverse effect:

Lots of complication and adverse effect are observed first is weight gain, sweating, feet burning tingling sensation in feet  

 

DISCUSSION:

Patient suffering form diabetes due to many reasons included less production of the insulin by beta cells of the pancreas or resistance of body against insulin, a major reason of Diabetes is genetics, majority of diabetic patient suffering from type 2 diabetes due to there genetics and family history. If this condition is not properly treated or is for long term it results in cardiovascular disease, shock, permanent damage eye and chronic kidney disease. Diabetic patient should properly manage his daily dietary intake because if patient is taking oral hypoglycaemic agents as medication and not taking diet according to body need then he may suffer from hypoglycaemic State that can be more dangerous then the hyperglycaemia. Small meals should be taken 4 to 5 time in a day instead of eating a lot at single time. Insulin or other hypoglycaemic agents should always be taken before 10 minutes of taking meals, because medicine or external source of insulin Will trigger the beta cells of the body to produce insulin inside the body the body according to need of body. Diabetic condition can also be treated by non- pharmacological method as by doing exercise, by stopping intake of High sugar content food.

 

CONCLUSION:

First investigation blood sample were collected and tested in which everything was Normal but in the urine sample collected higher level of glucose were found. When tested LFT and creatinine level was also normal .ECG was done it was also found to be normal normal. It was found that the patient Mr. Mahesh Babasaheb Kolap has improper diet and does not consume his medication time to time. Due to which even though after prescribing him the medicine his sugar level went on increasing. So after the follow-up he was asked to 14 units of insulin once in day. He was not taking the insulin on the time due to which again there was an increase in sugar level’  

So I Ms Nandini Bhise now suggested you to have a proper diet with lots of fiber intake, consume your medication time to time and follow up with the routine checkups.

 

REFERENCES:

1.     World Health Organization (2014) About diabetes.

2.     https://nation.com.pk/15-Nov..../who-rankIndia-7th-on-diabetes- Prevalence-list November  15 (2008) Diabetes prevelance.

3.     IDF(2016) International Diabetes Federation pp:13.

4.     Cooke DW plotnick L (2008) type 1dibetes mellitus Rev 29(11):374-384.

 

 

Received on 02.10.2022          Modified on 12.12.2022

Accepted on 23.01.2023     ©A&V Publications All right reserved