This document describes the medical history and examination of a 67-year-old female patient. She has a long history of type 2 diabetes, hypertension, polyarthritis, and functional psychosis. Recently she has experienced decreased appetite, vomiting, weakness, and irrelevant speech. Her diabetes was initially diagnosed in 1997. She has a family history of diabetes. Examinations show her blood sugar levels are well-controlled with metformin. The diagnosis is steroid withdrawal and hypocortisolism, with a possibility her diabetes was induced by previous drug treatment. Treatment includes deflazacort to address her steroid withdrawal and hypocortisolism.

1. Dr.S.ANBALAGAN

2. DISCUSSION
• NAME : KASTHURI
• AGE : 67
• SEX : FEMALE
• THIN BUILT
• KNOWN CASE OF T2DM / SHT /
POLYARTHRITIS / FUNCTIONAL
PSYCHOSIS
• ON REGULAR TREATMENT FOR DM
FOR THE PAST 15 YEARS
• VEGETARIAN , NOT A SMOKER,
ALCOHOLIC, TOBACCO CHEWER

3. COMPLAINTS
• DECREASED INTAKE OF FOOD
• VOMITING ON AND OFF FOR ONE
• GENERALISED WEAKNESS MONTH
• IRRELEVENT TALKS ON AND OFF
• H/O WITHDRAWAL OF ALL DRUGS FOR MORE
THAN ONE MONTH

4. HISTORY
• SHE DIAGNOSED AS T2DM IN 1997 WHILE SHE
WENT FOR AN EYE CHECK UP.
• HER PARENTS DETAILS ABOUT DM IS NA
• HER HUSBAND IS DIABETIC
• HAVING TWO SONS AND THREE DAUGHTERS. IN
THAT, EXCEPT ONE LAST SON, ALL ARE DIABETIC
• SHE UNDERWENT CATERACT SURGERY BEFORE 4
YRS FOR ONE EYE AND 1YR FOR ANOTHER EYE.
• VERY REGULAR Pt.

5. OLD RECORDS
DATE FBS PPBS
15.11.08 140 221
0912.08 110 242
09.01.09 144 176
19.01.09 284 378
19.02.09 186 320
20.03.09 134 169
21.04.09 112 221
21.05.09 134 241
20.06.09 132 160
22.10.09 142 248
08.06.10` 212 282
09.12.10 164 217
24.05.11 160 253
09.08.11 136 180
05.09.11 166 285
13.01.12 220 301
08.05.12 235 342
13.08.12 161 252

6. OLD RECORDS

7. OLD RECORDS

8. OLD RECORDS

9. OLD RECORDS

10. UNDERWENT RX

11. UNDERWENT RX

12. INVESTIGATIONS DONE
ECG

14. • USG ABDOMEN

15. PLAN
• MASTER HEALTH CHECKUP OF BLOOD AND
URINE

16. REPORTS

19. REPEAT FBS, PPBS, HbA1C
• FBS : 99mg/dl
• PPBS : 146mg/dl
• HbA1C : 6.3 %
• FROM A DIFFERENT STANDARDISED LAB

20. STILL MORE OLD RECORDS
• RECORDS FROM 97 TO 06 - MISSING

22. • SERUM CORTISOL

23. DIAGNOSIS
• STEROID WITHDRAWAL
• HYPOCORTISOLISM
• ?DRUG INDUCED DM
• GERD
• OA R KNEE

24. Rx GIVEN
• T.DEFLAZACORT 6mg
• 0-0-1 = 1 MONTH
• 0-0-½ = 1 MONTH
• ½ ONCE IN 2 DAYS= 1 MONTH
• T.METFORMIN 500mg
• 1-0-0
• PPIs
• VIT D3
• ALA+BT+MC
• T.LIBRIUM 10mg
• 0-0-1(SOS)

25. REPORT

27. QUESTION
• IN THE BEGINNING PT TOOK ONLY
METFORMIN FOR > 8 YRS
• WHEATHER THE Pt IS HAVING DM? WEATHER
WE NEED TO TREAT IT OR NOT?
• EVEN THOUGH THE S.CORTISOL IS BECOME
NORMAL ONCE I STOPPED THE STEROID Pt
HAD SAME COMPLAINTS BUT LESS INTENSITY.
• WAT ELSE WE CAN DO FOR THIS Pt?