MBBS-7th Semester NoMCTH (Biratnagar) FAMILY RECORD • Name (HOF): Dinesh Chaudhary • Age: 56 Year • Sex: Male • Religion: Hindu • Occupation: Shopkeeper • Address: Kharji, Biratnagar, Morang • Family Type: Nuclear Composition Of Family S.N. NAME AGE SEX EDUCATION OCCUPATION MARITAL RELATION (In STATUS With years) HOF
1. Mr. Dinesh 50 male SLC Shopkeeper Married HOF
Chaudhary
2. Mrs. Ranjan 47 female SLC Housewife Married Wife
Chaudhary
3. Mr. Rajesh 26 male Under- Civil Engineer Unmarried Son
Chaudhary mediate (+2) FAMILY TREE • Female • Male • Marriage • Sibling HEALTH PROBLEMS IN FAMILY • Mr. Dinesh Chaudhary suffers from Diabetes Mellitus • Other members are apparently healthy. Immunization Status Of Family • Immunization status of Mr and Mrs Chaudhary :- unknown • Their son and daughter are fully vaccinated and has immunization card . SANITARY ASSESSMENT OF HOUSE AND ENVIRONMENT SANITATION • Source of drinking water :- Piped water (tube wells) • Storage of water :- Fills bottles or jug directly from faucet. • Exposure to contamination of stored water :- No • Bathroom :- Present and Drained • Latrine :- Present and Used • Type of latrine :- Water Seal • Methods of refuse disposal :- Controlled Tipping • Preventive method observed : Use of mosquito net, phenyl HOUSING • Type of house :- Detached house • Roofing :- Terrace • Walls :- 10 inch Burnt Brick • Flooring :- Cemented • Lighting :- Adequate • Ventilation :- Adequate • cross ventilation: Inadequate • Electricity :-Present • Courtyard :- Present • Kitchen :- Satisfactory Housing continued…. • No. of rooms:-3 Living room, 1 Hall and 1 kitchen • Storage of food article:-Metal container • Total Floor area of living room :-100 sq.ft.× 3 • Total no. of occupants in house:-4 • Floor area per person:-75 sq.ft. • Overcrowding :-Absent • Dampness :-Absent • House flooded during rain:-No • Potential mosquito breeding areas :-Present SOCIO-ECONOMIC STATUS • Maternal and child health practices : good • Maintenance of personal hygiene : very well • Socioeconomic status of family: upper- middle class (kuppuswamy scale) • Monthly income – NRs. 35,000 • Total income and expenditure balanced • Economic condition : moderate INDEX CASE DIABETES MELLITUS Chief complaints/HOPI Chronic Fatigue and malaise ↑urination(Polyuria), ↑thirst(Polydypsia), ↑appetite(polyphagia) Tingling sensation and numbness in extremities Blurring of vision Family H/O: father was diabetic Clinical Examination General Examination • Ill looking, obese (BMI-25) but Orientated to time, place and person • No Pallor, Icterus, Cyanosis, Clubbing, Lymph Node enlargement and Dehydration • pitting Edema present in face > both ankles Vitals B.P. – 125/85 mm Hg Pulse – 80 BPM R.R. – 16 breathes/min. Temp. - 37°C Provisional diagnosis: diabetes mellitus INVESTIGATIONS: A. Blood glucose and glycated Hb 1. Fasting plasma glucose ≥ 126 mg/dl OR, 2. 2-hour plasma glucose ≥200mg/dl following OGTT (intake of 75 anhydrous glucose) OR, 3. Random plasma glucose ≥200mg/dl + classic symptoms of DM OR, 4. HbA1c ≥ 6.5% Note – A/C to WHO repeat the test to confirm for asymptomatic patients and never use capillary blood for Diagnosis of DM. B. Urine glucose and urine protein 1. Urine glucose 1-2 hour following meal to ↑sensitivity 2. 24-hour Albumin ≥ 300mg/L in urine , ketone bodies absent. C. c-peptide and Islets autoantibodies -Normal (rules out Type1 DM) D. ECG and Chest-X ray – Normal E. GI endoscopy-no abnoramlities F.LIPID PROFILE Final Diagnosis – Type 2 Diabetes Mellitus MANAGEMENT A. Non-pharmacological-Life style/diet modification B. Pharmacological- 1. Oral Hypoglycemic Agents – • DOC/First line drug – metformin • 2nd line drug selected based on efficacy, hypoglycemic risk,wt.effects,and other side effects efficacy Hypoglycemic Weight Other Side costs risk effects effects
Sulphonylurea High Moderate Gain Hypoglycemia Low
(Tolbutamide,…, )
Thiazolidinedione High Low Gain Edema Low
(pioglitazone,..)
DPP-4 inhibitor Moderate Low Neutral Rare High
(sitagliptin,…)
SGLT2 inhibitor Moderate Low Loss Dehydration High
(dapagliflogin,…)
GLP-1 agonist High Low Loss GI distress High
(exenatide,..)
Insulin(Basal) Highest High Gain Hypoglycemia Variable
2. Treatment of HTN,Obesity,dyslipidemia CHD if present 3. treatments of edema , muscle pain, and infections e.g. skin lesions, and UTI care of feet . PREVENTION and CONTROL • Primary prevention –population strategy (diets, exercise ) and high risk strategy ( avoid alcohol, smoking, control cholesterol) • Secondary prevention –early Dx and Tx • Tertiary prevention –limitation of disabilities e. g. blindness, renal failure,diabetic foot,CHD etc. by organising diabetic clinics and diagnostic centre. THANK YOU