This case presentation discusses a 81-year-old male patient diagnosed with type 2 diabetes mellitus and uncontrolled blood sugar. Type 2 diabetes is characterized by high blood sugar due to insulin resistance or lack of insulin production. The patient's medical history and lab results are presented. His treatment plan involves multiple oral hypoglycemic agents and lifestyle modifications to control his blood sugar levels and comorbidities like hypertension. Drug interactions and counseling points are also outlined.
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The number of people with diabetes rose from 108 million in 1980 to 422 million in 2014.
Prevalence has been rising more rapidly in low and middle-income countries than in
high-income countries.
Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke, and lower
limb amputation.
Between 2000 and 2016, there was a 5% increase in premature mortality from diabetes.
In 2019, an estimated 1.5 million deaths were directly caused by diabetes. Another 2.2 million deaths were attributable to high blood glucose in 2012.
A healthy diet, regular physical activity, maintaining a normal body weight, and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.
Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication, and regular screening and treatment for complications
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1. CASE
PRESENTATION ON
TYPE 2 DIABETES MELLITUS
Submitted by : B.RAJU
Pharm D 2 Year
19HF1TOOO5
Submitted to : Dr. sridevi mam
2. INTRODUCTION:
Type 2 diabetes formerly knows as adult onset disease is a form of
diabetes that is characterised by high blood sugar, insulin resistance and
lack of insulin
With type 2 diabetes ,the body either doesn’t produce enough insulin(beta
cells) ,or it resists insulin
ETIOLOGY
• Resistant of insulin
• Genetic predisposition
• obesity
3. SYMPTOMS:
Polyuria , Polydipsia ,Polyphagia
Weight loss , Blurred vision , Fatigue
Headache , Poor wound healing
Diagnosis :
Type 2 diabetes mellitus can be diagnosis by blood
test i.e fasting blood glucose , oral glucose tolerance
test ; following strict diet ,weight loss , healthy
eating , exercise and through medications
6. SUBJECTIVE DATA
Name : B . Dathaiaha
Dr name : k .s . ashok kumar
Age : 81 yrs
IP no: IP210301076
Sex : male
Ward : male medicine ward
Unit : 1 ; DOA : 1/3/2021
c/o : patient came for cataract surgery , k/c/o : DM ,
HTN
7. PMHx : patient was asymptomatic for 1 month and decrease
vision suffering from HTN (20 years) ; type 2 diabetes mellitus (20
years )
FMHx : Not significant
SHx : mixed diet , bladder movement regular , smoker , alcholic
VITALS :
Temperature : Afebrile
Pulse rate :76
CVS:s1s2 +ve
Respiratory rate :18cycles /min
Respiratory system : BAE +ve
8. OBJECTIVE DATA
Hb 11.8gm%
RBC count 4.3m/cmm
T. WBC 8900cell/cmm
Neutrophills 68%
Lymphocyts 23%
eosnophills 02%
Monocytes 07%
Basophills 00 %
Platelets 2.6 lakhs/c
Hematology
Bilirubin total 0.5mg/ml
direct 0.2mg/dl
AST(SCOT) 23u/l
ALT (SGPT ) 20U/L
ALP 120 gm%
Total protein 7.5gm%
Albumin 3.9gm%
Globulin 3.6gm%
LFT
FBS 251mg/ml
PPBS 276mg/ml
RBS 568mg/ml
HbAIC 9.9%
B.Urea 91mg/dl
Sr. creatinine 2.7mg/ml
Biochemistry
9. s. Cholesterol 157 mg/dl
HDL 72mg/dl
TG 117mg/dl
LDL 62 mg/dl
TC/HDL 157 mg/dl
Lipid profile Urine analysis
Appearance Clear
Colour Pale yellow
Reaction 5.0
Specific gravity 1.015
10. ASSESMENT
• Base on the subjective and objective data the patient
has been diagnosed with type 2 diabetes mellitus
• Provisional diagnosis : type diabetes mellitus with
uncontrolled blood sugar
• Final diagnosis : diabetes mellitus type 2
11. PLAN
Current drugs Dose Frequency ROA Generic name Comment
Inj .insuman comb BD IV Insuman comb To reduce glucose
levels
Tab vildagliptin 50mg OD PO Vildagliptin To treat diabetes
Tab ceruvin 5mg OD PO Clopidogrel Antiplatelet agent
Tab Bio D3 0.25mg OD PO Calcitriol Chronic renal
dialysis
Tab homo DIP 5mg OD PO Methylcobalamine Vit B12 & folic
acid supplement
Tab strovas 40mg OD PO Atorvastatin To treat
hyperlipedmia
Tab met XL 12.5mg OD PO metoprolol Hypertension
Tab dytor 10mg OD PO Torsemide Hypertension and
CHF
Rx
12. Tab climidipine 10mg OD PO Clinidipine High bp
Tab angiospan 10mg OD PO Glyceryl
trinitrate
To treat angina
pectoris
Tab rabee 10mg OD PO Rabeprazole Proton pump
inhibitor
Tab febuday 40mg OD PO Febuxostat Anti gout
medicine
Tab Sorbinitrate 5mg OD PO Iso dinitate To treat chest
pain
13. PHARMACIST INTERVENTION
• The patient is advised to go with electrolytes test
because as the sugar and sugar subtitutes can cause
spiking in blood sugar levels maintaining your
electrolyte balance is crucial , in this cause it is
important
14. DRUG INTERACTIONS
• ATORVASTATIN ↔ CLOPIDROGEL
This combination may reduce the effects of clopidrogel, if you have any
signs of blood clots ,shortness of breath ,sudden loss of vision swelling
immediately consult an physician
• METOPROLOL ↔ TORSEMIDE
This may lower blood pressure and slows your heart rate causes
dizziness
DRUG FOOD INTERACTIONS
Grape juice can increase the blood levels of atorvastatin this can increase
the liver damage and leads to RHABDOMYLOSIS
15. PATIENT COUNSELLING
About disease :
It is a lifelong disease and it needs necessary modifications in the lifestyle
pattern strictly use the prescribed medication
About drugs :
• If we skip the dose ,should not double the dose
• Take prescribed medications at right time
• TAB rabee should be taken in the morning before breakfast
• Be careful while taking insulin (INSUMAN COMB) should be taken 30
minutes before food ; insulin should be stored in refrigerator
• Take isosorbide dinitrate during emergency only
16. LIFE STYLE MODIFICATIONS
• Eat healthy get plenty of vegetables such as carrot ,broccoli beans ,cabbage
& fruits such as carrot ,kiwi ,banana mango
• Choose non fat dairy and lean meats
• 30 minutes of Exercise such as walk, gym this may reduce your stress and
brings your sugar levels down
• Get regular checkups
• Manage stress through yoga breathing exercise
• Stop smoking and alchol
• Maintain healthy body weight
• Enough sleep
17. DIET CHART
• Carbohydrates such as brown rice, whole wheat , oat meal
foods to avoid white bread , sugar flour cookies
• Protein food such as beans, legumes, eggs, seafood, dairy,
poultry
• Include chia seeds , apple cider vinegar
18. References
• drugs.com ( www.drugs.com )
• medscape ( www.Medscape.com )
• Comprehensive pharmacy by LEON
SHARGEL
• Pharmacotherapy by joseph T dipiro
• Pharmacology by K.D TIRPATI
