Scribd
Upload
2 views

MS case

Mr. Vijay Madhukar Sirohi is a 47-year-old male with a history of type 2 diabetes mellitus, currently asymptomatic and well-managed on medication. He has a supportive family and a mixed diet, but faces challenges such as a sedentary lifestyle, daily alcohol consumption, and obesity. The patient is advised to adopt dietary changes, exercise regularly, and monitor his health to prevent complications.

Uploaded by

Hrishikant Sahay
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
2 views

MS case

Mr. Vijay Madhukar Sirohi is a 47-year-old male with a history of type 2 diabetes mellitus, currently asymptomatic and well-managed on medication. He has a supportive family and a mixed diet, but faces challenges such as a sedentary lifestyle, daily alcohol consumption, and obesity. The patient is advised to adopt dietary changes, exercise regularly, and monitor his health to prevent complications.

Uploaded by

Hrishikant Sahay
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 5

MS CASE

My patient Mr. Vijay Madhukar Sirohi , 47 year old male resident of wanowrie bazaar
married and educated till 10 th standard. He is Hindu by religion and works as a food
and beverage supervisor at the turf club
My patient is a known case of type 2 DM since last 4 years on regular medication and
follow up and is currently asymptomatic.
HOPI-My patient was apparently asymptomatic 4 years back when he developed
tingling and numbness in right leg which was insidious onset and gradually progressive
, intermittent localised to right foot and ankle . The patient consulted his family
physician regarding these symptoms and was advised investigation in which his blood
sugar levels were found to be elevated fasting -140 and PP-190mg/dl.
He was started on oral hypoglycaemic medication.His symptoms gradually subsided
upon taking medication and he is taking regular medication since then. He is having
monthly follow ups and regular investigations, and is currently asymptomatic with
normal blood sugar profile.
There is no history of tingling, numbness in other extremities.
No h/o polyuria, polydipsia, polyphasic
No h/o blurring of vision
No h/o recurrent boils;UTI, delayed wound healing, chronic cough
No h/o swelling of feet/ extremities
No h/o oral ulcers, foot ulcers
No h/o chest pain, breathlessness, loss of consciousness, nausea , vomiting, fainting,
lightheadedness
Past history-No history of previous hospitalisation / comorbidities
Family history-Father was known diabetic expired at the age of 60 years , cause of
death not documented
Mother is known hypertensive live with his brother
Siblings -2 brothers , non diabetic
Personal history – Consumes mixed diet
Consumes alcohol two large pegs daily since last 10 years
No h/o tobacco consumption in any form
Normal bowel bladder habit
General examination- patient is sitting comfortably in chair and is well oriented to
time , place , person
Height-170cm, weight-85 kg, BMI-29.41 kg/m2 , BP-130/ 80mm hg right arm sitting
No pallor, icterus, cyanosis, clubbing ,edema, lymphadenopathy
No xanthelesma , tendon xanthoma, acanthosis nigricans
No oral thrush, ulcer, onychomycosis
No digital tremors
Systemic examination
CNSHMF normal
Cranial nerves normal
No focal neurological deficit
Motor and sensory examination-WNL
Respiratory- bilateral vesicular sounds
No adventitious sounds
Abdominal-soft , non tender , no palpable organomegaly , bowel sounds present
CVS-s1s2 normal, no murmurs
Investigation 10 oct 19- blood sugar fasting-109, PP-146
ECG-WNL, HbA1c-6.6, lipid profile-WNL
Medical diagnosis-47 year old male vijay Madhukar known case of type 2DM on oral
hypoglycaemic agents with good adherence to treatment and regular follow up with no
complications and no adverse effects of medication.

Social history
Family composition – Nuclear family with 4 members
S.no. Relationship Age Health status
1. Wife 44. Healthy
2. Daughter 21. Healthy
3. Son 19. Healthy
IDRS risk scoring
Wife high risk (score70)
Daughter low risk(score 10)
Son moderate risk (score 50)

Place of stay - Native


Health services – UHTC (200metre)
CH SC-4 km
Family doctor
Transportation facility – 1bike and 1activa
Personal history-Job history- joined turf club 4 years ago with erratic work schedule
Relationship with employer good
Family relationship and bonding present
Nutritional history
Mixed diet
24 hr recall calorie intake 2545 kcal
Calorie requirement 1700 kcal (20 kcal /kg)
He had 3 major meals with evening tea and snacks and alcohol in the night
Breakfast -egg Bhurji. 160 kcal
Milk. 160 kcal
4 chapati. 320 kcal.
Lunch. Mix veg. 240 kcal
4 chapati. 320 kcal
Dal 100 kcal
Tea with 2 veg sandwich. 475 kcal
Evening. Alcohol. 350 kcal (120 ml)
Snacks. 400 kcal
Dinner. Mix veg. 240 kcal
Chapatis. 320 kcal
Dal. 100 kcal

Total. 2545 kcal


Housing. Pucca house with no uneven, sharp surfaces
Ventilation and lighting adequate
Standard of living
Total income -20000/ month
Expenditure on food, transport, education, recreation etc -15000/month
Socioeconomic class according to modified Kuppuswamy scale -lower middle
Factors in individual -patient aware about disease complication , importance of
adherence to medication and regular follow up takes medicine regularly and has
positive attitude towards health care facility
Factors in family -family members are cooperative , family members ensure that he
gets daily medication and has regular follow up
Factors in Community – neighbours are helpful and cooperative . They are ready to
provide him help of any nature.
SWOT analysis –
Strength-positive attitude towards health case facility
Regular follow up and daily medication
Supportive family members and neighbours
CH (SC) as health care facility near by
Weakness-sedentary life style
Daily alcohol consumption
Erratic work schedule
Improper diet
Obesity
Only earning member
Opportunity- screening of other family members
Counselling and motivation to cut down alcohol intake and reduce weight
Avail services at CH SC for fundoscopy
Threats-complications of diabetes
Family history of hypertension
Alcohol related disorder
Metabolic syndrome
Threat of loss of job
Social pathology-family history of diabetes
Obesity
Daily alcohol consumption
Sedentary life style
Erratic work schedule
Improper diet
Social diagnosis my patient Vijay Madhukar 47 year old a case of type 2diabetes on
regular medication with good adherence and regular follow up and no complications .
Patient gives positive family history , sedentary life style , improper diet and erratic
work schedule with daily alcohol consumption
Social therapy – medical management tab glimipride 1 mg bd
Tab metformin 500 mg bd
Dietary advice – low glycemic index food
High fibre diet with daily fruit consumption
Low saturated fat diet
No fasting , frequent meals , snacks before exercise
Biscuit etc in pocket with diabetic card
Lifestyle- exercise brisk walk 30 min /day
Alcohol restriction
Weight reduction
Self care in diabetes- hand and feet care
Use of digital tools /apps like health e diabetes(calorie check)
Pedometer(physical activity)
Blood glucose e log book
Questions and answers
What are cardinal symptoms of DM and which comes first?
Polyuria, polydipsia, polyphagia. Polyuria comes first (osmotic diuresis)
2-what are classes of oral hypoglycemic agents?
Biguinides-metformin
Sulfonylurea-glimipride
Thiazolidone-pioglitazone
GLP1analogue-exentide
Meglitinide
DPP4 inhibitors-sitagliptan
3. What are advantages of metformin?
Cheap, less weight gain, lesser risk of hypoglycaemia
4- What are genetic linkages in DM?
Family history more common in type 2 where as Type 1 is HLA linked( HLA
DR3- DR4, DQ)
5- what are signs/symptoms look for alcoholic patient ?
Digital tremors, sleep disturbances, parotid enlargement
6- what is CAGE criteria?
C- want to cut off alcohol
A-annoyance
G-guilt
E- eye opener
7- What is IDRS?
Indian diabetes risk score
4 component 1-age , physical activity , WC, family history
8- What is orthostatic hypotension ?
Fall of systolic blood pressure more than 10 mmhg and diastolic blood
pressure by 20 mmhg within 3 min
DD pregnancy
9- What is CPI?
Consumer price index having industrial , agriculture, rural components . It is
under department of labour and is updated monthly
10- What is cut off WC in obesity ?(Indian)
WC more than 90 cm in male and 80 cm in female
WHR (1) in male and 0.85 in female(cut off)
11- criteria for metabolic syndrome
Waist circumference > 102 cm in male and 88 cm in female
TG >150
Fasting blood glucose more than 100 mg /dl
HDL less than 40 in male and less than 50 in female
Blood pressure more than 130/85( 3/5 criteria required)

You might also like