CASE PRESENTATION ON

Type2 Diabetes Mellitus-II with

Primary Hypertension
Presented By:
Monika Kapoor
Pharm. D (2nd year)
Department of Pharmacy Practice
I.S.F College of Pharmacy, Moga 142001, Punjab,
INDIA
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Date:09/02/2016
 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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 TYPES
• TYPE I :- Type I DM is also called as insulin-dependent
Diabetes Mellitus (IDDM) or juvenile-onset diabetes
and characterized by the loss of insulin producing β-
cells of the islets of langerhans of pancreas.
• TYPE II :-Type II DM is also called as non insulin
dependent Diabetes Mellitus(NIDDM) and
characterised by hyperglycaemia, insulin resistant and
impaired insulin secretion.
• GESTATIONAL DIABETES:- It is characterised by
inadequate insulin secretion during the pregnancy.
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 SIGNS AND SYMPTOMS

TYPE I DM:
1. Polyuria
 2. Hunger
 3. Fatigue
 4. Dry mouth
 5. Itchy skin
 6. Blurred vision.
SIGNS AND SYMPTOMS
1. TYPE II DM:
2. 1. Polyuria
3. 2. Weight loss
4. 3. Slow healing sores or cuts
5. 4. Pain in feet or legs.

 GESTATIONAL DIABETES:
1. Polydipsia
2. Polyuria 6

3. Fatigue
 SELF MONITORING TEST
• Self-monitoring of blood glucose

• Extremely useful for outpatient monitoring specially for patients who

need tight control for their glycemic state.

• A portable battery operated device that measures the color intensity

produced from adding a drop of blood to a glucose oxidase paper
strip.

• e.g. One Touch, Accu-Chek, DEX, Prestige and Precision.

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 WHAT IS HYPERTENSION?

DEFINITION: HYPERTENSION IS DEFINED AS

PERSISTENT ELEVATION OF ARTERIAL BLOOD
PRESSURE MORE THAN 140/90 MM OF HG. (JONIT
NATIONAL CPMMITTEE -8 GUIDELINES)

NORMAL ARTERIAL BLOOD PRESSURE : 120/80 MM

OF HG (NORMAL STANDARDS)
ETIOLOGICAL CLASSIFICATION OF
HYPERTENSION
A. Primary HYPERTENSION (90%)
1.Genetic factor
2.Racial and environmental factors
3.Risk factors modifying the course
B. SECONDARY PERTESION (10%)
1.Renal causes
2.Endocrine
3.Cardiovascular
4.Neurogenic
RISK FACTORS FOR
HYPERTENSION

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 ACCORDING TO JOINT NATIONAL
COMMITTEE
(JNC -7) CLASSIFICATION
CATEGORY SYSTOLIC DIASTOLIC
(mmHg) (mmHg)
NORMAL 120 80

PRE- HYPERTENSION 120-139 80-89

STAGE 1 HYPERTENSION 140-159 90-99

STAGE 2 HYPERTENSION ≥160 ≥100

 SUBJECTIVE

PATIENT DETAILS
NAME: XYZ WEIGHT: 62 Kg.

AGE:37 Yrs. D.O.A:15/12/2015

SEX: MALE Ward: Medicine unit-I

HEIGHT: 5’8ft.
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 OBJECTIVE
PHYSICAL FINDINGS

General: conscious; well oriented to place , time and person

BP : 160/100mm of Hg
BODY TEMP: 98.7ºF
S1 S2: Normal; no murmur heard
Reflexes: Normal
CVS:
Edema – -ve
Icterus – -ve
Pallor – -ve
Koilonychia – -ve
Cyanosis – -ve
Clubbing – -ve
Lymphatic Node
Enlargement – -ve
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 OBJECTIVE

C/O
Patient was presented with c/o high blood pressure
Past Medical History
Known case of Diabetes mellitus since past 4 years
Past Medication History
Inj. Insulin
Social History
Patient was chronic alcoholic since past 15years with
addiction of opium
Allergy History
NKDA
Family History
no such family history
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 ASSESMENT DIAGNOSIS
The patient has been diagnosed with Type -II Diabetes mellitus as the patient was suffering
from high levels of random blood sugar and urine sugar and Elevated Blood Pressure

Time RBS Urine

sugar
03-01-2016
9 P.M 350mg/dL ++++
11:30P.M 431mg/dL ++

04-01-2016
1:30P.M 320mg/dl ++
4 A.M 271mg/dl ++
6A.M 326mg/dl ++

05-01-2016
9:30A.M 186mg/dl Trace
11 am 250mg/dl Trace

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 lab Observed value Normal value
Investigations

urea 36mg/dl 15-45mg/dl

serum creatinine 0.8mg/dl 0.8-1.3mg/dl

sodium 146mEq/l 135-155mEq/l

potassium 5.0mEq/l 3.5-5.5mEq/l

Bilrubin 0.9mg/dl 0.3-1.1mg/dl

ALT 38IU/dl 5-40IU//dl

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ALP 145IU/dl 60-150IU/l
 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 Pregabalin 75 mg O BD Anticonvulsant

M +
Mecobalamin 750 mcg

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

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Inj. Lasix Furosemide 10mg IV OD Loop diuretic

 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.

 Opium cessation.

 Patient should follow proper medication

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 PHARMACISTS INTERVENTIONS
No major drug-drug interactions were found:-

• Patient was not prescribed with any of the oral hypoglycaemic agents.

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TREATMENT
NONPHARMACOLOGICAL THERAPY
Activity

- Exercise improves insulin resistance and achieving glycemic control.

- Exercise should start slowly for patients with limited activity.

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 PATIENT
COUNCELLING
D-DIETARY
• A-APPROACHES TO
• S-STOP
• H-HYPERTENSION
• DIET rich in fruits
Vegetables and low fat dairy food.
Control:
Ca , Mg,& K-25%
Macronutrient and fibers
Thank you…
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