DEPARTMENT OF PHARMACY PRACTICE

ANNAI JKKMRF”S sampoorani ammal college of pharmacy

Komarapalayam

Data collection

Case no: Date:

Patient name: Age: sex: male / female

Height : weight: BP:

Type of diabetes mellitus:

1.cardiovascular
Co-morbidity: disease
2.cancer
3.hypertension
Complication: 4.liver
5.kidney
6.dysphagia
7.others
Diabetes mellitus theraphy:

Cost: high low moderate

Refill:
before tablet over After tablet over 2 days over
Genetic disorder: Yes / No

Blood sugar tests:

FBS : [3.9 to 5.4 mmols/l] (70 to 99mg/dl)
RBS : [4.4-8.9 mmol/l](80-130mg/dl)
PPBS: [5-7.2mmol/l] (90-130mg/dl)
HBA1C:

Types of treatment:

1.oral: yes /no 3.both: yes/no

2.insulin: yes /no
Insulin injection:
~rapid-acting.
~short-acting.
~long-acting.
~intermediate-acting.
Oral drug:
1. sulfonylureas tolbutamide glibenclamide glipizide gliclazide glimepiride
2. Meglitidine/phenylalanine repaglinide Nateglinide
analogues
3. GLP-1(injectable drugs) Exenatide liraglutide
4. DPP4-4 inhibitors Sitagliptin Vildagliptin Algogliptin linagliptin Saxagliptin
Algogliptin
5. Biguanide(AMPk activator metformin PPARγ pioglitazone
activitaor
6. Glucosidase inhibitors acarbose miglitol voglibose
7. Amylin analogue Pramlintide
8. Dopamine D2 receptor bromocriptin
9. SGLT-2 inhibitor dapaglifloxine