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Uncontrolled Type 2 DM

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Darshan R
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23 views29 pages

Uncontrolled Type 2 DM

Uploaded by

Darshan R
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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CAsE PRESENTATION On

UNCONTROLLED TYPE 2
DIABETES MELLITUS
PRESENTED BY:
SINCHANA
2 nd Pharm D
DIABETES MELLITUS:
Definition:
Diabetes mellitus is a chronic metabolic disorder
characterised by elevation in the blood glucose leads to all the time
serious damage to heart, eyes, kidney, nerves, and blood vessels.
Etiology:
• Autoimmune
• Idiopathic
• Genetic
• Environmental factors
• Drugs
• Physical inactivity
• Obesity.
Pathophysiology :
Increase in fat accumulation

Insulin resistance

Decrease in glucose uptake.

Type 2 Diabetes mellitus.


Clinical manifestations:
• Increased thirst
• Frequent urination
• Increased hunger
• Unintended weight loss
• Fatigue
• Blurred vision
• Slow healing sores
• Frequent infections
• Numbness or tingling in the hands or feet
• Areas of darkened skin, usually in the armpits and neck.
PATIENT DEMOGRAPHIC DETAILS
 Name : XYZ
 Age : 55 Years
 Sex : Male
 I.P No. : 23-25028
 Unit : MED-C
 DOA : 01/03/2023
 DOD : 05/03/2023
CHIEF COMPLAINTS :
 C/O Easy fatigue since 1 week
 C/O Bilateral knee joint pain since 1 week.
• PAST MEDICAL HISTORY :
K/C/O Type 2 Diabetes mellitus.
• PAST MEDICATION HISTORY :
Tab. Metformin 1000 mg P/O 1-0-1+
Tab. Glimepride 4 mg P/O 1-0-1+
Tab. Voglibose 0.3 mg P/O 1-0-1.
• PERSONAL HISTORY :
Diet-Mixed ; Sleep-Regular;
Appetite-Normal; B/B- Regular and normal.
• FAMILY HISTORY : Nothing significant.
• SOCIAL HISTORY : Nothing significant.
PHYSICAL EXAMINATION :
• BP : 130/70mmHg
• CVS : S1,S2 heard ,no murmur.
• CNS : Conscious and oriented.
• P.R : 76bpm
• Temp: 95 degree F.
• R.S : B/L NVBS+ .No added sounds.
• SpO2: 97%@RA
• R.R : 18cpm
• P/A : Soft, non tender.
LABORATORY INVESTIGATION:
• S.Cr : 0.7mg/dl
• Urea : 22mg/dl
• Sodium: 136mmol/L
• Potassium : 3.5mmol/L
• Chloride : 94mmol/L
• PPBS : 500mg/dL(Less than 140 mg/dL)
• HbA1C : 14%
• T.Chol : 102mg/dL
• T.Gs : 83 mg/dL
• VLDL: 16.6mg/dL
• LDL: 49mg/dL
• HDL: 37mg/dL
• Hb : 13.4gm/dL
• TC: 12,200cells/cumm
• N : 86%
• L : 10%
• M : 4%
• E : 0%
• B : 0%
• RBC : 4.70million cells/mcL
• TC : 9470cells/cumm
• Platelet : 6.42lakhs/cumm (
• PCV : 39.5%
• Urine analysis:
 Colour : pale yellow
 Protein: nil
 Sugars: 0.5%
 Casts : nil
 Epi cells : 2-3/HPF
 Pus cells : 3-4/HPF
 Crystals : Nil
SOAP ANALYSIS FOR BRONCHIAL
ASTHMA
SUBJECTIVE EVIDENCE:
C/O Easy fatigue since 1 week.
C/O Bilateral knee joint pain 1 week.
K/C/O Type 2 DM.
.
OBJECTIVE EVIDENCE:
PPBS : 500 mg/dL
HbA1C : 14%
Sugars in urine : 0.5%
ASSESSMENT:
Based on objective and subjective
evidence it was diagnosed as
UNCONTROLLED TYPE 2 DIABETES
MELLITUS.
THERAPEUTIC GOALS
PATIENT SPECIFIC:
To relieve easy fatigue.
To relieve bilateral knee joint pain.
DISEASE SPECIFIC:
To normalize the abnormal values of PPBS
and HbA1C.
To prevent the complications.
ASSESSMENT ON CURRENT
THERAPY
DRUG DOSE ROUTE FREQU DAY 1 DAY 2 DAY 3 DAY CLASS
NCY 4

Inj.Mocef.S 1.5g IV 1-0-1 + + + + Cephalosporin+be


(Ceftriaxone+Sulbactum) ta lactamase
inhibitor.

Inj.Pan 40 mg IV 1-0-0 + + + + Proton pump


(Pantoprazole) inhibitor

Inj.Emeset 4 mg IV S-O-S Antiemetic.(5HT3-


(Ondansetron) Antagonist)
Tab.Dolo 650 mg P/O S-O-S Analgesics and
(Paracetamol) Antipyretics.

H.Actrapid 50 units in IV + + + + Insulin preparations


infusion 500 ml NS

IVF NS/RL IV + + + +
PROGRESS CHART
DAY 1
CLINICAL
DRUG DOSE ROUTE FREQUE PROGRE
NCY SS
Inj.Mocef.S 1.5gm IV 1-0-1 BP=130/70mm
Inj.Pan 40mg IV 1-0-0 Hg
Inj.Emeset 4mg IV SOS PR=76bpm
Tab.Dolo 650 mg P/O SOS RR=18cpm
H.Actrapid 50 units in 500 SpO2=97%@RA
infusion ml NS IV
IVF NS/RL IV
DAY 2

CLINICAL
DRUG DOSE ROUTE FREQUEN PROGRES
CY S

Inj.Mocef.S 1.5gm IV 1-0-1 BP=140/90mmHg


Inj.Pan 40mg IV 1-0-0 PR=116bpm
Inj.Emeset 4mg IV SOS RR=17cpm
Tab.Dolo 650 mg P/O SOS SpO2=100%@RA
H.Actrapid 50 units in 500 ml
infusion NS IV
IVF NS/RL IV
DAY 3
CLINICAL
• DRUG
•DOSE
DRUG DOSE ROUTE FREQUE PROGRE
• ROUTE NCY SS
• DRUG
•DOSE
• ROUTE Inj.Mocef.S 1.5gm IV 1-0-1 BP=134/92mm
• Inj.Pan 40mg IV 1-0-0 Hg
•FREQUENCYInj.Emeset 4mg IV SOS PR=80bpm
•CLINICAL PROGRESS
Tab.Dolo 650 mg P/O SOS RR=24cpm
•FREQUENCYH.Actrapid 50 units in 500 SpO2=100%@R
•CLINICAL PROGRESS
infusion ml NS IV A
IVF NS/RL IV Easy fatigue
relieved.
DAY 4

CLINICAL
DRUG DOSE ROUTE FREQUE PROGRE
NCY SS
Inj.Mocef.S 1.5gm IV 1-0-1 BP=126/88mm
Inj.Pan 40mg IV 1-0-0 Hg
Inj.Emeset 4mg IV SOS PR=80bpm
Tab.Dolo 650 mg P/O SOS RR=17cpm
H.Actrapid 50 units in 500 SpO2=98%@RA
infusion ml NS IV Patient feel
IVF NS/RL IV better.
Planning

DISCHARGE MEDICATIONS:
• Tab.Pan -40mg 1-0-0 P/O .
• Tab.Dolo 650mg SOS P/O .
• H.Actrapid infusion- 50 units in 50 ml NS IV.
• Tab Taximo O 200 ( Cefixime 200 mg)
GOALS ACHIVED
• Easy fatigue relieved.
• Bilateral knee joint pain relieved.
MONITORING PARAMETERS
• Inj.Mocef.S : Rash, Diarrhea.
• Inj.Pan : Nausea, vomiting, constipation, fatigue.
• Inj.Emeset : Hypotension, Flushing, sedation.
• Tab.Dolo : Nausea , vomiting, Tachycardia, fatigue.
• H.Actrapid infusion : Hypoglycaemia, insulin resistance, blurred vision,
hypokalaemia.
• Tab Taxim o 200 : Nausea , vomiting, Headaches, Rash.
• Tab Metformin : Vitamin B12 deficiency , taste disturbance, loss of appetite, lactic
acidosis.
• Tab Glimipride : Hypoglycaemia, haemolytic anaemia, liver failure, abdominal pain.
• Tab Voglibose : Hepatotoxicity, skin reactions, pain.
MONITORING PARAMETERS
REFERENCE:
• Inj.Mocef.S : Tata 1 mg
• Inj.Pan : CIMS page no. 28
• Inj.Emeset: CIMS page no.57
• Tab. Dolo : CIMS page no.182
• H.Actrapid infusion: CIMS page no.334
• Tab. Cefixime : CIMS page no.240
• Tab.Metformin : CIMS page no.345
• Tab.Glimepride : CIMS page no.338
• Tab.Voglibose : CIMS page no. 349
PATIENT COUNSELLING
DISEASE SPECIFIC:
•Avoid sugar, honey, jaggery, sweets, white rice, white bread.
•Wear well- fitting, protective foot wear.
•Regular exercise is essential.
•Try to cut down on fat, particularly animal fat, sugar and sugary food.
•Try to eat atleast five portions of fruit and vegetables every day.
•Keep rapidly absorbed carbohydrates on hand.
DRUG SPECIFIC
• Tab.Dolo : Paracetamol may be taken every 4 to 6 hours.Leave at least
4 hours between doses.
• Tab. Taxim o 200 : Continue to take cefixime even if you feel better.
• H.Actrapid infusion : Take it 20 -30 minutes before a meal.
REFERENCE
• CIMS (Apr-July 2023)
• Medscape
• TATA 1 mg
• MedlinePlus
thank you

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