case of uncontrolled blood sugar with diabetes foot ulcer
Case
35 year old Male who is a Biochemistry teacher by occupation came with a chief complaints of
• Pain in the left lower chest region since 19 days
• Vomitings since 14 days
History of presenting illness
▪Patient was apparently asymptomatic 7 years back then he had fall from bike due to fainting then he was diagnosed as diabetic at local hospital since the he was on medication( metformin- 500 mg) regularly till 2019 and was on regular checkup monthly with dietary practices
▪ He used to drink alcohol occasionally since 2008.He started drinking alcohol heavily since 2019 January due to personal problems and wasn't on regular medications for diabetes then after 2 weeks he had vomiting and abdominal pain for which he was hospitalized and diagnosed acute pancreatitis and his blood sugar levels was very high for which he was given insulin form then he was on GLYCOMET -MV1 (metformin and voglibose)
▪ Then he stopped drinking alcohol for 2 months during this period of 2 months he was alright
▪Then he again started drinking and was not regular on diabetic medication and then he had recurrent episodes of abdominal pain following heavy drinking for which he stops taking alcohol for 2 days and then he resumed again
▪3 years ago patient had corn on plantar aspect of great toe, patient himself used to cut the thickened part with a blade, which one year ago turned into an ulcer, for which he underwent debridement 1 year ago and 4 months back. He does his own dressing by using spirit to clean and the area and then puts iodine and cotton on it, every alternate day but it was not healed and some times he had pain which was radiating upto ankle joint
▪He quit his job 2 years ago and suicide attempt ( op poisoning) ,only staying at home since then, but occasionally teaches as a guest lecturer.
▪ He quit his job 2 years ago and is only staying at home since then, but occasionally teaches as a guest lecturer.
▪ He had accident 19 days back when he was drunk and then he developed pain and swelling but he neglected it because he was on alcohol totally and did not take any food Pain which was gradually increased which was throbbing type and non radiating and increased on taking deep breath and on lying on left lateral position relieved on medication
▪ After 4 days he had single episode of vomiting at night which was blood stained so he stopped taking alcohol and next day about 10 to 15 episodes and which was non bilious initially and bilious there after and non projectile and contents as food particles and there was sudden increase in pain of lower chest for which he came to our hospital and he was not taken any medication for diabetes since 10days He was given Zofer for vomitings and IV fluids were given and his sugar levels were 500-600mg/ dl he was put on Insulin for first 2 days he was normal then he developed all over the body but they continued itching for next 2 days then he had severe itching all over the body ( avil was given) so insulin was stopped and was given oral medication glimiperide 4mg morning , metformin 500 mg morning and glimiperide - 3 mg , metformin 500 mg night. He want' s go to de - addiction centre but his sugar levels are not controlled he was sent back
Past history
▪ Known case of diabetes since 8 years
▪No history of hypertension, asthma, epilepsy, CAD
1 year back.. he attempted suicide..( op poisoning)
Family history
Not significant
Personal history
Diet- mixed
Appetite- normal ( does not take food when he consumes alcohol )
Sleep- inadequate( when he does not take alcohol)
Bowel and bladder movements- regular
Habits- consumes alcohol from 2009 occasionally but from 2019 consumed daily , smokes while drinking about 5 to 6 each time
General examination
Patient was conscious , coherent, cooperative well oriented to time , place person
Pallor- mild
icterus- absent
cyanosis- absent
clubbing- absent
Lymphadenopathy - absent
Edema- absent
VITALS-
Temp: 98°F
PR: 78bpm
RR: 18 cpm
BP: 120/80 mm hg
SpO2: 98% on RA
GRBS-
• 15/3/2022- 500 to 600 mg/dl
•16/3/2022
2AM (16/3/22): 101mg/dl
6AM (16/3/22): 97 mg/dl
8 AM ( 16/3/22): 144 mg/dl
•18/03/2021
8am- 323mg/dl
10am- 259 mg/ dl
1pm- 251mg/ dl
3pm- 245 mg /dl
7pm -245 mg/ dl
•22/3/2022
8am -310 mg /dl
10am - 277mg/ dl
•24/3/2022
4 am- 171 mg/dl
7am -341 mg/dl
10am- 250 mg/dl
11am -166 mg/dl
3pm- 341 mg/dl
•25/ 3 /2022
4am -171g/dl
7am -341 mg/dl
1pm- 209 mg/dl
7pm -166 mg/dl
10 pm- 209mg/dl
•26/ 3/2022
7am - 166 mg/dl
10am- 304 mg/dl
3pm- 296mg/dl
7 pm -201mg/dl
10pm- 269mg/dl
•27/ 3/ 2022
6 am- 271 mg/dl
8am- 169 mg/dl
10am-- 306 mg/dl
2pm- 117 mg/dl
Systemic examination
S. Amylase: 74 IU/L
Urine for ketone bodies: negative
•LFT:
TB: 1.08
DB: 0.24
AST: 18
ALT: 10
Alk P: 242
TP: 7.3
Alb: 4
A/G: 1.23
•ABG:
