Diabetes outcomes study patient online record 1

Semistructured data:

A 45yr old female patient admitted in hospital with chief complaints of joint pains since 2 days, peripheral edema since 3 months,SOB ,constipation, burning micturation, decreased urine output and increased appetite since 15 - 20 days. Also complaints of blurred vision occasionally and neuropathic pain in both lower limbs since 3 months. She is diagnosed for diabetes 7 years ago and HTN 6 years ago. She was on oral hypoglycemic drugs but it didn’t control the blood glucose levels then shifted to Biphasic isophane Insulin 25U BID since 6 years. Unable to bear the pain (diabetic neuropathic pain) in the lower limbs, she herself started taking inj tramadol 2ml (100mg) in veins. 


Diastolic dysfunction with EF= 65% was seen in color doppler.   

Her biochemistry investigation of liver shows increased total bilirubin and direct bilirubin(1.2 and 0.73mg/dl resp.), sgpt is slightly increased (44IU/l) and albumin(3.6 gms/dl) is slightly decreased. Her sugar is in good control(HbA1c: 7.0%) but present she has FBS as 122 mg/dl and RBS OF 327mg/dl and serum creatinine, serum electrolytes and blood urea is normal.

Partial pressure carbon dioxide, PCO2 and oxygen,PO2 is slightly reduced with PH(7.43) remains normal. In urine examination albumin is found trace amounts and sugar in urine is 4+ and found negative for ketone bodies in urine. Bilateral parotidomegaly is seen on physical examination. USG report of parotid gland shows fatty infiltrate of bilateral parotid glands, subMandibular glands and thyroid lesions of Indeterminated aetiology.
              
 Bilateral parotidomegaly:        

Swelling and IV Drug use injuries(Tramadol Injections taken by self ):

   

Due to insomnia this patient was referred to psychiatric department.

Her monitoring glucose levels are as shown in below images:            

Anterior and lateral views of trunk:

                Trunkal fat lateral view

               Bipedal edema below

      Bilateral knee OA:

       Acanthosis nigricans (a bioclinical marker):

   

     Link to structured proforma 

https://medicinedepartment.blogspot.com/2018/11/structured-proforma-for-open-labeled.html?m=1

Structured proforma for an open labeled non randomized pilot trial to study diabetes patient outcomes

Code Name:                                   Age:         Gender:

Confidential information not to be revealed  contact no:                                    Address:

Heart rate:                  Weight:           kgs      Height:             cms                    BMI:

Diagnosis: Type 2 Diabetes mellitussince _____________ yrs. Co-morbidities: Hypertension               hyper/ hypo thyroidism Current complains:          Pictures taken (if needed):                               consent taken :                    stored in :

Current medication: S.no medication dose route frequency 1 2 3 4 5

Weekly evalauation data:

S.no	parameters	week
		1st	2ND	3RD	4TH	5TH	6TH
1	Weight(kgs)
2	BMI
3	FBS
4	PPBS
5	BLOOD PRESSURE
6	EXERCISE
7	FOOD (CALORIE)

S.no	parameters	week
		7Th	8Th	9Th	10Th	11Th	12Th
1	Weight(kgs)
2	BMI
3	FBS
4	PPBS
5	BLOOD PRESSURE
6	EXERCISE
7	FOOD (CALORIE)
S.no	Blood and urine Test			Baseline values	After the study/3months	Difference(%)
1	HbA1c
2	Fasting blood sugar
3	Blood urea nitrogen
4	Serum creatinine
5	TSH
6	Serum electrolytes
	A)	Sodium(Na+)
	B)	Potassium(K+)
	C)	Chloride(Cl+)
	D)	Calcium (Ca++)
	E)	Magnesium(Mg++)
7	Fasting lipid profile
	A)		LDL
	B)		VLDL
	C)		HDL
	D)		TG
	E)		T Chl
8	Urine sugar
9	Urine microalbumin
10	Urine ketones
11	Urine Creatinine

One of the outcomes is to " determine the fraction of patients found to be able to engage in moderate intensity postprandial exercise, as counselled, during the week and detected by way of HbA1c measured at the beginning and end of the 12 week protocol"

The other outcome is to test the role of a chemical known for its GLP1 facilitation