DIABETES MELLITUS

Group 2
Senthamizh.R
Shanthini.V
Sharumathi.A
Shikha Bhardwaj
Shree Arthi.G
Shubha Harinii.S
General Information
• Name: Velu
• Age/Sex: 40 yrs/Male
• Religion: Hindu
• Address: Kodapakkam
• Occupation: Mason
• Education: 4th Standard
• Colour of ration card: Red
Nearest health facility
• Nearest Health care Facility: Kodapakam PHC
• Distance from home: 500m
• Time taken to reach: 10- 15 mins by walk
• Why they chose IGMC&RI : Better treatment
 Family Profile

Name Relation Age/ Education Occupat Monthl Marital Comorbiditie Covid Are they
to HOF Sex ion y status s vaccination screened
income status for NCD
(if>30yrs)
Velu Head 40y/ 4th std Mason 5000 Married DM Vaccinated Yes
M with 2 dose
Adhilakshmi Wife 38y/F uneducated Coolie 3000 Married ------ Vaccinated Yes
with 2 dose

Kavendran Son 9Y/M 4st Std ----- ----- ----- ----- ----- -----
Pedigree charting
 Socio economic history

• Monthly income of family: 8000

• Per capita income: 2666.66
• Socio economic status: Class III (according to
modified BG prasad Scale)
• Debts/loans: No
Chief complaints
• Abdominal pain for 2 days
• Giddiness for 2 days
• Vomiting for 2 days
History of presenting
illness
• The patient was apparently normal 2 days before
after which he developed abdominal pain which
was acute in onset, intermittent in nature and
relieved on medications.
• He then presented with giddiness and vomiting.
Vomiting is of 10 episodes which does not contain
blood.
• The patient came to casualty in unconscious state,
admitted in ICU and was diagnosed as Diabetic
ketoacidosis.
• He has h/o thirst , polyuria.
• No h/o puffiness of face , pedal edema , reduced
urine output (s/o diabetic nephropathy , CKD)
• He has h/o blurred vision , coloured halos (s/o
diabetic retinopathy)
• No h/o chronic cough and purulent sputum
suggestive of TB.
• He has history of burning micturition after
catheterization.
• No h/o epistaxis.
• No h/o blood transfusion.
• No h/o of chest pain, palpitations , breathlessness.
Course of illness
• Patient had and RTA during which he was injured
and admitted to general hospital 4 years back

There patient underwent some tests and was

diagnosed with diabetes mellitus

On diagnosis patient was started on TAB

METFORMIN . He was on medications for 6 months
• After which he was started on subcutaneous INSULIN
due to uncontrolled blood sugar

Patient had stopped taking his INSULIN doses for last 1

month . After which they developed DKA
Treatment history:

 He was diagnosed to have type-2 Diabetes mellitus 4

years ago in IGMC&RI and was prescribed TAB
METFORMIN. He was on medications for 6 months.
 Later he was started on S/C INSULIN.
 The patient did not take insulin therapy for the past 1
month.
Past history
• K/c/o type -2 Diabetes mellitus for past 4 years.
• No history of hypertension.
• No H/o surgery.
• No history of Covid infection in the past.
• No history of asthma , tuberculosis, seizures
• He has h/o jaundice for which he was treated 1
year ago.
• No history of blood transfusion.
Personal history
• Consumes mixed diet
• No H/o smoking.
• H/o of alcohol in take for past 20 years. Last binge
of alcohol was taken on 13th April. He consumes
375 ml of Brandy daily.
• Normal bowel and bladder habits
• Sleep disturbances present.
Family history
• Nuclear family.
• Non consanguineous marriage.
• No family h/o DM &HTN.
Psycho social history
• Good interaction with neighbours.
• Participates in family functions.
• Supported by family members.
DIET HISTORY:
• He consumes mixed type of diet.
• Number of meals consumed in a day is 3.
• Staple diet is rice.
• Frequency of vegetable / fruit intake:
weekly one day fruits
Everyday vegetable.
• No food faddism.
• No habit of placing salt in dinning table.
• Per capita salt and oil consumption:

salt consumption= 600 g/ month(iodised salt)

= 6.6 gm/person/day

oil consumption= 1.5 l/month(refined ground

nut oil)
=16.67ml/person/day
24 hour recall method:
TIME FOOD QUANTITY CALORIE PROTEIN
TAKEN VALUE VALUE
Morning Tea 1 cup 75 3

Breakfast Idly 3
1cup
225
110
7.5
4
Sambhar

Lunch Rice 1cup

2cup
170
220
2.56
8
Sambhar

Evening Tea 1cup 75 3

Dinner Dosa 2
2tbsp
250
120
2
1
Coconut
chutney
 Recommended Intake comment

CALORIE(kcal) 2448kcal 1245kcal Deficient by 49.14%

(1203 kcal)

PROTEIN(gm) 50.7gm 31.06gm Deficient by 38.7 %

(19.64gm)
 Environmental History
• Type of house: Own,Kutcha
• Total No of living rooms: 2
• Overcrowding is not present according to room per person
criteria
• Separate Kitchen is present.
• Type of fuel used: LPG
• No indoor air pollution
• Source of drinking water: Municipality
• Boiling of water not practiced
• Method of retrieval of water: dipping glass
• Household latrine is present.
• Domestic waste is collected and disposed of by municipality
• Mosquito breeding sites are present.
• Stray dogs present.
• Street lights present.
• No pets in the house.
KNOWLEDGE:
• he knows that DM is chronic non communicable disease and has genetic
predisposition
• he knows complication of his illness
• he knows about dietary modification, salt and oil restrictions
• he is aware of the role of physical exercise to his illness

ATTITUDE:
• he understands the need for taking continuous treatment for chronic
illness
• he is willing to visit the hospital in case of any complication
• he is willing to practice simple physical exercise

Practice:
• he is not practicing split meal technique and avoids sweet and sugary
substance.
• he is going for walking for an hour daily
• Not wearing MCR footwear because he fells uncomfortble wearing it
GENERAL EXAMINATION:
• The patient is conscious and well oriented to
time, place and person, co-operative for
examination.
• No pallor, icterus, cyanosis, clubbing,
lymphadenopathy, edema.
VITALS:
• Afebrile .
• Pulse: 74/min , Normal rate, rhythm, volume ,
character, no arterial wall thickening.
• BP: 130/80 mm Hg
• RR: 22/min.
 SYSTEMIC EXAMINATION
CVS Examination :
● S1,S2 heard normally
● No murmurs

RS Examination :
● Normal vesicular breath sound
● No added sound

ABDOMEN Examination :
● Soft , non tender.

CNS Examination :
● No focal neurological deficits.
ANTHROPOMETRY:
• HEIGHT: 168 cm
• WEIGHT: 60 kg
• BMI: 21.25 kg/m2( Normal according to
ASIAN CLASSIFICATION of BMI)
• Waist Circumference: 99 cm (Normal
value=80cm)
• Hip Circumference: 95 cm
• Waist Hip Ratio: 1 .04.
FOOT EXAMINATION:
• Inspection on both feet.
• Colour : no pallor, cyanosis, erythema
• Skin: No dry/ shiny skin/ hair loss s/o PVD
• No eczema No painful areas
• No Ulcer on both foot.
• Swelling : no oedema suggestive of venous insufficiency / heart
failure
• Presence of calluses
• Venous filling :no guttering of veins /reduced visibility of vein s/o
PVD
• No deformity in foot caused by neuropathy
• No cracks, fissures , amputation or claw toes/ ingrowing toe nails.
PALPATION OF FOOT:
Right foot Left foot
Temperature Afebrile Afebrile

Capillary refill time normal (about 2 sec) normal ( about 2 sec)

Peripheral pulses felt felt

(dorsalis pedis
artery,post.tibial artery)

Sensation (fine and Absent Absent

crude touch)

Proprioception present present

Vibration sense present present

Ankle Reflex Present present

Summary
• Mr. Velu,40 yr old male from Kodapakkam came to
IGMC&RI and got admitted on 15/4/23 (Tuesday)
with the chief complaints of abdominal pain which
was acute in onset, intermittent in nature, vomiting
and giddiness for 2 days. His nutrition is deficient in
calorie by 49.14% and protein by 38.7% .He is a
known case of alcoholic for past 20 yrs.
 CLINICAL DIAGNOSIS

Mr.Velu, 40 years old male of BMI 21.25 kg/m2 (normal as per

ASIAN classification ), is a known case of Type 2 Diabetes mellitus
for the past 4 yrs and he is on insulin .He is diagnosed with Diabetic
ketoacidosis.
Family diagnosis
• It is a Nuclear family consists of 3 members with
1 eligible couple living in kutcha own house residing
in Kodapakam,comes under class IIl socioeconomic
class, according to modified BG Prasad scale.
Management
At individual level
Advised to continue the INSULIN for DM
Advised him:
for regular check up atleast once in a month
to take medication regularly
to follow DASH diet
to follow split meals
include food items with low salt content and low glycemic index
like Green vegetables, most fruits, raw carrots, kidney beans,
chickpeas and lentils
to do mild physical activity
• At family level
• Providing support mentally and financially
• Ensuring that he takes insulin regularly
• Dietary modifications
• Sensitizing them regarding awareness about
disease progression and complications
• At community level
• Early case detection by regular screening of
population above 30 years of age.
• Health promotion for behaviour and lifestyle
modification by organizing various camps, posters,
banners etc.
• National Programme for Prevention and Control of
Cancer, Diabetes, Cardiovascular disease and Stroke
(NPCDCS)