40M T1DM ; Chronic Atrophied Pancreatitis
https://syedsadathhussainirollno156.blogspot.com/2024/04/40m-type-1-dm-with-uncontrolled-sugars.html
Case History and Clinical Findings
C/O - LOSS OF CONSCIOUSNESS AT AROUND 3 AM SINCE 20 DAYS
C/O OF GIDDINESS SINCE 1 WEEK
C/O NAUSEA SINCE 1 WEEK
C/O WEAKNESS SINCE 1 WEEK
HOPI:-
PATIENT WAS APPARENTLY ASYMPTOMATIC 20 DAYS AGO THEN DEVELOPED HYPOGLYCEMIC SYMPTOMS AT AROUND 3 AM AND PATIENT BECAME UNRESPONSIVE.
PATIENT WOULD BECOME NORMAL AFTER HAVING SOME SUGAR SYRUP OR CHOCOLATE
SIMILAR EPISODE HAS BEEN OCCURRING ON A DAILY BASIS FROM PAST 1 WEEK.
NO H/O SWEATING, PALPITATIONS, DURING THAT EPISODE .
NO H/O VOMITING,BLURRING OF VISION DURING THAT EPISODE.
H/O CONSUMPTION OF LESS FOOD DURING NIGHT TIME
H/O WHICH HYPOGLYCEMIC EVENT OCCURRED EARLY IN MORNING
NO H/O FEVER ,LOOSE STOOLS
NO H/O BURNING MICTURITION,DECREASED URINE OUTPUT
NO H/O POLYUREA , POLYDYPSIA,POLYPHAGIA .
NO H/O SIMILAR COMPLAINTS IN A DAY TIME
PAST HISTORY
K/C/O - TYPE -1 DM SINCE 23 YEARS AND ON MEDICATION INJ.BIPHASIC ISOPHANE INSULIN BD 10ml [ 40 IU /ml ] ( mrng &night ) since then
K/C/O - CHRONIC PANCREATITIS SINCE 2 YEARS
N/K/C/O - HTN,ASTHMA,TB,EPILEPSY,CAD,CVA,THYROID DISORERS
TREATMENT HISTORY
DIABETES - ON MEDICATION INJ.BIPHASIC ISOPHANE INSULIN BD 10ml [ 40 IU /ml ] ( mrng &night ) FROM PAST 23 YEARS
PERSONAL HISTORY
OCCUPATION - AUTO DRIVER
ADDICTIONS - OCCASIONAL ALCOHOL DRINKER - WHISKY 45 ML / 15 DAYS BUT STOPPED 2 YEARS AGO
FAMILY HISTORY - INSIGNIFICANT
GENERAL EXAMINATION
PT.CONSCIOUS , CO HERENT , CO OPERATIVE
WELL ORIENTED TO TIME PLACE ,PERSON
BP - 120/70 mmhg
PR - 86 bpm
TEMP - 98 F
GRBS - 293 mg/dl as on 28-04-2024 ,time - 10:30 am
NO PALLOR,ICTERUS , CYANOSIS ,LYMPHADENOPATHY ,OEDEMA ,CLUBBING
SYSTEMIC EXAMINATION
CVS- S1S2 HEARD ,NO MURMURS , NO THRILLS
RS - NVBS,POSITION OF TRACHEA - CENTRAL , NO DYSPNOE,WHEEZE , NO ADDED SOUNDS
P/A - SOFT , NON TENDER, NO PALPABLE MASS , NO ORGANOMEGALY
CNS - NFND
REFLEXES : BICEPS TRICEPS SUPINATOR KNEE ANKLE
RIGHT 2+ 2+ 1+ 2+ 1+
LEFT 2+ 2+ 1 + 2+ 1+
PALNTARS - FLEXOR
CEREBRAL SIGNS - ABSENT
GAIT - NORMAL
MUSCULO SKELETAL SYSTEM - NORMAL
SKIN - NORMAL
EXAMINATION OF BREAST - NORMAL
EXAMINATION OF HEAD AND NECK - NORMAL
EXAMINATION OF TEETH AND ORAL CAVITY -NORMAL
EXAMINATION OF ENT - NORMAL
COURSE IN HOSPITAL:
40 YEAR OLD MALE CAME WITH HISTORY OF HYPOGLYCEMIC EVENTS SINCE 20 DAYS .PATIENT IS KNOWN DIABETIC SINCE 22 YEARS AND HE IS ON MIXTARD INSULIN 10 UNITS SUBCUTANEOUS BD .PATIENT WAS SHIFTED TO HUMAN ACTRAPID INSULIN ON ADMISSION AND SUGARS WERE MONITORED .LATER SHIFTED TO INJ GLARGINE.PATIENT IS ABLE TO MAINTAIN HIS SUGARS.SO PATIENT IS BEING DISCHARGED WITH INJ GLARGINE .
Provisional Diagnosis:-
TYPE -1 DIABETES MELLITUS
ATROPHIED PANCREAS SECONDARY TO ALCOHOL
Investigation:-
HBsAg-RAPID 25-04-2024 12:34:PM
Negative
Anti HCV Antibodies - RAPID 25-04-2024 12:34:PM
Non ReactiveBLOOD UREA 25-04-2024 12:34:PM
18 mg/dl 42-12 mg/dl
SERUM CREATININE 25-04-2024 12:34:PM
1.1 mg/dl 1.3-0.9 mg/dl
SERUM ELECTROLYTES (Na, K, C l) 25-04-2024 12:34:PM
SODIUM 136 mmol/L 145-136 mmol/L
POTASSIUM 4.3 mmol/L 5.1-3.5 mmol/L
CHLORIDE 103 mmol/L 98-107 mmol/L
