SHORT CASE

(DIABETIC EDUCATOR
COURSE 2021 JKNJ)
DR NAVINA, SN FARIDAH, PPP OMAR
 CASE 1: BIODATA PESAKIT
Madam S, 58 yrs old
Housewife
Weight: 58kg
Height : 156cm
BMI: 23.8 kg/m2
Waist circumference: 81cm
No hx of smoking/ alcohol intake
NEWLY DIAGNOSED DM on 6th Feb 2022
 Came to KKBI for right big toe ulcer PROBLEM LIST:-
dressing post I&D transferred in from 1) Newly diagnosed DM
KPL Mahmoodiah 2) Active diabetic foot problem
 Noted during visit to KKBI
Fasting GM: 9.3, BP: 137/85, PR: 55  Started with T.Metformin 500mg BD
Clinically well, no fever  Planned for full blood ix
 Referred dietician
no hypoglycemic/hyperglycemic sx
 Right foot examination: dry and has
peeling of skin, ulcer over the plantar
region of the toe with pus discharge.
Swab c&s was taken.
 2 ND
VISIT
 FBS: 6.7, BP: 158/84, PR: 63
 Added T. Amlodipine 5mg OD
 3RD visit, BP: 142/84, PR: 86, fasting GM : 8.5
- fbs at home ranging 6.5-7.5
- T. Metformin increased to 1g BD
- T.amlodipine was off, add T.Perindopril 4mg OD
 INVESTIGATIONS
 HbA1C: 14.4%
 LFT normal
 RP: UREA: 5.37, CREAT: 59.7, EGFR: 97 (Stage 1)
 Lipid profile:TC: 4.02, TG: 1.69, HDL: 0.82, LDL: 3
 Urine microalbumin: albumin 2+, abnormal ratio: 155mg/g
 No proper SMBG
 MANAGEMENT
 For proper BSP monitoring and home BP monitoring
 T. Metformin 1g BD, T. Perindopril 4mg OD
 Repeat urine microalbumin in 3/12 again
 Advice on foot care, foot education
 Advice of strict diabetic diet
 Repeat HbA1c in 3/12 again
 Awaiting dietician review
 To counsel for insulin on next visit
 CASE 2
 Mr O, 55 years old gentleman
 Weight: 72
 Height : 166cm
 BMI: 26.4
 Waist circumference: 91cm
 Risk factors : strong family hx of DM
 No hx of smoking/ alcohol intake
 DM DIAGNOSED ON 1/11/2020
 Diagnosed as DM during CVD screening
 Was started on T.Metformin 1g BD and T.Gliclazide 80 mg BD
 On 5th April 2021, noted BP 158/95, repeated BP: 149/93, PR: 68, GM : 16.4,
Hba1c: 8.5%
 Patient was on T.Amlodipine 10mg OD, T. Cardiprin 100mg OD, T.Gliclazide
160mg BD and T.Gemfibrozil 300mg OD
 On 26/4/2021, patient complaint of diarrhea after taking metformin and was
taking his self purchased T. Proglutrol( Glimepiride 2mg+T.MTF SR 500mg OD)
 Patient was then started with T. Metformin XR 500mg OD, T.Gemfibrozil was
off an started with T. Simvastatin 10mg ON.
 Patient was referred for DMTAC, dietician.
TCA 25/5/21 24/8/2021 21/12/21 10/1/22 15/3/22
DATE
BP 134/90, PR 68 146/90, 144/87, PR: 139/88, pr: 70 132/86, PR: 85 130/88, PR: 91
66
GM 13.2 15.5 10.0 ® 10.9 ® 10.5 ®
MO - Claimed lack of
NOTES sleep, took 3 bread,
oats and banana
SMBG - Ranging from 7.5- Prebreak: 7.5-8.5 Fasting: 7.4-8.8 Premeal: 6.9-9.5
10.5 Premeal: 5.1-7.6 2HPP: 4.9-8.2 Postmeal: 5-6.3
LIST OF 1) T.Amlodipine 1) T.Amlodipine 1) Off bisoprolol 1) T.perindopril 1) T.perindopril 4mg
MEDICA 10mg OD 10mg OD 2) + T.perindopril 4mg OD OD
TIONS 2) T. Cardiprin 2) T. Cardiprin 4mg OD 2) T.Amlodipine 2) T.Amlodipine
100mg OD 100mg OD 3) T.Amlodipine 10mg OD 10mg OD
3) T. Gliclazide 3) T. Gliclazide 10mg OD 3) T. Cardiprin 3) T. Cardiprin
160mg OD 160mg OD 4) T. Cardiprin 100mg OD 100mg OD
4) Increase T. 4) T. MTF XR 1g 100mg OD 4) T. Gliclazide 4) T. Gliclazide
MTF XR 1g OD 5) T. Gliclazide 160mg OD 160mg OD
OD 5) T. Simvastatin 160mg OD 5) T. MTF XR 5) T. MTF XR 1.5g
5) T. Simvastatin 10mg ON 6) T. MTF XR 1.5g OD OD
10mg ON 6) + T.Bisoprolol 1g OD 6) T. Simvastatin 6) T. Simvastatin
6) + T.Bisoprolol 2.5mg OD 7) T. Simvastatin 10mg ON 10mg ON
2.5mg OD 10mg ON
 INVESTIGATIONS
DATE 31/3/2021 13/12/2021
HbA1c 8.5% 6.5%
Renal Profile Not done

Liver TP: 87.2, Alb: 44.1, ALP: 99.4,

Function test ALT: 16.7, TB: 13.82, AST:
25.6
Fasting Lipid TC: 5.06, TG: 1.62, HDL: 0.95,
Profile LDL: 4

 ECG (5/4/21): Sinus rhythm

 Fundus camera: Bilateral eyes normal findings
 Foot assessment: Sensory intact
DMTAC REVIEW
 DIAGNOSIS
 Well controlled DM
 Hypertension
 Hyperlipidemia
 MANAGEMENT

1) For regular BSP and BP monitoring

2) Routine yearly screening (full blood profile+HbA1c)
3) Aim HbA1c <7 %, BP<130-139/70-79
4) Urine microalbumin/UFEME
5) DMTAC
6) Refer dietician
7) Foot assessment
8) Repeat yearly fundus camera