25.02.

2015
CASE PRESENTATION ON
Type2 Diabetes Mellitus
Presented By:
Manik chhabra(1339198) ,
Piyush Sikka(1339207),
Manpreet singh(1339199)
PharmD (2nd year)

Department of Pharmacy Practice 1

ISF College of Pharmacy, Moga 142001, Punjab, INDIA

 CASE
SUMMARY
My patient was male with 42 years of age was admitted on 30-01-15 in medicine 3
with history of drug overdose (heroin) and had difficulty in breathing. He was
suffering from Diabetes mellitus from past 10 years. On admission RBS of patient
was monitored and it was abnormal i.e 539 mg/dL . Patient was having diabetic
complications like ketourea , glycosuria and Patients creatnine clearance ,blood
urea was above the normal level.
X

Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia and abnormalities in carbohydrate, fat, and protein metabolism .It results from defects
in insulin secretion, insulin sensitivity, or both. Chronic micro vascular, macro vascular, and neuropathic complications may ensue. Diabetes is further of two types-:
Type-1 DM (10%) Earlier called IDDM or Juvenile-onset DM
Type 1A: Immune mediated ( Autoimmune destruction of β-cells which usually leads to insulin deficiency. Type 1B: Idiopathic (Patients are negative for autoimmune markers)

Type 2 DM (80%) Earlier called NIDDM, or maturity onset DM (MOD): Although Type-2 DM predominantly affects older individuals, its now known that it also occurs in
obese adolescent children; hence the term MOD is inappropriate now a days .Moreover, many Type-2 DM patients requires insulin therapy to control the hyperglycemia or to
prevent ketosis and thus are not truly NIDDM.

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 Introduction
Diabetes mellitus (DM) is a group of metabolic disorders characterized
by hyperglycemia and abnormalities in carbohydrate, fat, and protein
metabolism.

It results from defects in insulin secretion, insulin sensitivity, or both.

Chronic micro vascular, macro vascular, and neuropathic complications

may ensue.

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 Symptoms
TYPE 1 DM:
Individuals with type 1 DM are often thin and are prone to develop
diabetic ketoacidosis if insulin is withheld or under conditions of
severe stress with an excess of insulin counter regulatory hormones.
Between 20% and 40% of patients present with diabetic ketoacidosis
after several days of polyuria, polydipsia, polyphagia, and weight loss.

TYPE 2 DM:
Patients with type 2 DM are often asymptomatic and may be
diagnosed secondary to unrelated blood testing.
However, the presence of complications may indicate that they have
had DM for several years.
Lethargy, polyuria, nocturia, and polydipsia can be present 5
on
diagnosis; significant weight loss is less common.
 SUBJECTIVE
PATIENT DETAILS
NAME: XYZ WEIGHT: 70 Kg.

AGE:42Yrs. BLOOD GROUP- O +VE

SEX: MALE WARD: MEDICINE-iii

HEIGHT: 5’9ft. D.O.A: 14/01/15

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 OBJECTIVE
PHYSICAL FINDINGS:

A)CNS: Patient was irritated, conscious and well oriented to place, person and
time.

B) CVS:
Edema – -ve
Icterus – -ve
Pallor – -ve
Koilonychia – -ve
Cyanosis – -ve
Clubbing – -ve
Lymphatic Node
Enlargement – -ve

C) BP : 120/100 mm of Hg

D) TEMP : 98.7ºF
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E) RR: 22/min
 OBJECTIVE CON’T
C/O
Patient was presented with H/0 drug overdose (heroin)difficulty in breathing since 1 day.

Past Medical History

Known case of Diabetes mellitus since past 10 years

Past Medication History

On O.H.A

Social History
Patient was chronic alcoholic since past 10 years 500L per day and addicted to
heroin

Allergy History
NKDA

Family History 8
no such family history
 LABORATORY INVESTIGATIONS
Lab. Investigations Observed value Normal Value

MCV 87.7 fLa 76-96 fLa

MCH 30.2 pg 27-32 pg
MCHC 34.5% 31-35%
RBC 5.44 X 1012 /L 4.3-5.9 X 1012 /L
Neutrophils 64 % 40-70%
Eosinophils 0.1% 1-4%
Basophils 0.0% 0-0.5%
Monocytes 5% 2-8%
Lymphocytes 12.6 % 20-45%
Platelets 2.78 lakhs/cumm 1.5-4 Lakhs/cumm
WBC 9000 cumm 4000-10000 cumm
Hemoglobin 16.4g/dL 2.4-7 mg/dl
Sr. Creatinine 1.4 mg/dl 0.8-1.3 mg/dl
SODIUM 138 mEq/L 135-155 mEq/L
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POTASSIUM 4.9 mEq/L 3.5-5.5 mEq/L
CHLORIDE 100 mEq/L 98-107 mEq/L
 LABORATORY INVESTIGATIONS

Lab. Investigations Observed value Normal Value

CALCIUM 8.6mg/dl 9.2-11.0 mg/dl

Bilirubin Total 0.5 mg/dl 0.3-1.1 mg/dl
ALT 18 IU/l 5-40 IU/l
ALP 152 IU/l 60-150 IU/l
RBS 539 mg/dl <140 mg/dl
AST 20 IU/l 5-40 IU/l
Total Sr. Protein 6.8 g/dl 6.5-8 g/dl
Hemoglobin 14 g/dl 14-18 g/dl
RBC 4.94*10^12 /L 4.3-5.9 *10^12 /L
Total cholesterol 169 mg/dl >200 mg/dl
HDL 55 mg/dl 40-59 mg/dl
Triglycerides 148 mg/dl >150 mg/dl
Blood Urea 52mg/dl 15-45 mg/dl

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 Assesment DIAGNOSIS
The patient has been diagnosed with T2 Diabetes mellitus as the patient was suffering from
high levels of random blood sugar and glycourea and ketourea.

Time RBS Urine Urine ketone

sugar
15-01-2015
9 P.M 575mg/dL ++++ Large 6ml
11:30P.M 431mg/dL ++ Large 6ml

16-01-2015
1:30P.M 320mg/dl ++ Large 6ml
4 A.M 271mg/dl ++ Large 4ml
6A.M 326mg/dl ++ Large 3ml

17-01-2015
9:30A.M 186mg/dl Trace Moderate 1ml
12:00P.M 250mg/dl Trace Large 2ml
11 P.M 192mg/dl Trace Large 2ml

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 Plan Treatment and Progress
MEDICATION GENERIC NAME DOSE ROUTE FREQUE Mechanism of action
DAY-1 NCY
Inj.Humisulin Short acting 1 ml I.V 6ml per Reduces blood glucose
insulin equivalent infusion hour level
` to 4 units

Inj Augmentin Amoxicillin 1g Beta-lactam

antibacterial
Potassium I.V 8 hrly
Clavulanate 200mg Betalactamase
inhibitor

Tab.Pregalin M Pregabalin 75 mg O BD Anticonvulsant

Mecobalamin 750 mcg

Inj.Pantium Pantoprazole 20 mg I.V OD Proton pump inhibitor

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Inj.Meromac Meropenem 1g I.V TDS Inhibits cell wall

synthesis of bacteria
 Treatment and Progress
DAY-1 contd....
MEDICATION GENERIC NAME DOSE ROUTE FREQUE Mechanism of action
NCY
Tab. Naxdom Domperidone 10 mg O TDS inhibitor of COX-1 and
OT Naproxen 250 mg -2
DAY-2

The same medications as on DAY 1 were continued .

DAY-3

Out of the medications given on DAY 2 . Inj. Augmentin was omitted. Rest were given as
indicated above
DAY-4

The same medications as on DAY 1 were continued .

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 Treatment and Progress

Progress
DATE BP PULSE RR RBS

15-01-15 137/94 mm of 92 per min 32 per min 431 mg/dL

hg

16-01-2015 120/90mm of 86 per min 22 per min 326 mg/dL

hg

17-01-2015 140/90 mm of 74 per min 25 per min 186 mg/dL

hg

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 PATIENT COUNSELLING
 Reduce sodium intake as it serves as therapy for hypertension.

Engage in aerobic exercise because aerobic exercise improves insulin resistance and
glycemic control in most patients and may reduce cardiovascular risk factors, contribute
to weight loss or maintenance, and improve well-being

Patient was advised to stop drinking alcohol .

 Patient was advised to decrease saturated fat and cut down intake sugar, sugary foods

Increase intake fiber – carbohydrate absorption≈15 g of soluble fibers/day.

Heroin cessation.

Patient should follow proper medication adherance

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 PHARMACISTS INTERVENTIONS
No major drug-drug interactions were found minor one is-:

 Naproxen + Pantoprazole

 Pantoprazole causes early degradation of the enteric coated naproxen , causing

medicament to be released too early in the body ,this makes naproxen less
effective

MANAGEMENT: Instead of pantoprazole same class drug omeprazole can be used or

other class drug can also be used like Rantidine

 Their was therapeutic duplication as patient was prescribed with meromac along
with augmentin .

 Patient was not prescribed with any of the oral hypoglycemic agents.

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p
Thank you…
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