1. DIABETES MELLITUS
SaravananMK
SathiyaPriya
SelvaSurya
Shalini
Shandilyan
ShynthiaDevi

2. A 70 years old named Lakshminarayanan ,
working as a priest , from a nuclear family of
upper lower class in sankar nagar , came with
complaints of ulcer in both the legs. He is a
known diabetic and was brought in an
ambulance and was admitted in TVMCH 17
days back.

3. History Of Presenting Illness
• H/O ulcer on the left foot , for the past 2
months in the dorsal aspect , which was
healing , but worsened after he met with a
trauma due to RTA 20 days back

4. History Of Presenting Illness
• H/O ulcer on the right foot for the past 2
weeks. It started as a small vesicle and bursted
out leaving a raw surface which gradually
increased in size reaching the present size.

5. • H/O discharge from the wound for the past 20
days in the left foot and for the past 2 weeks
in the right foot.
Copious in amount
Purulent in nature
Blood stained
Foul smelling

6. • H/O tingling sensation in both the legs for the
past 2 weeks.
• H/O hyperpigmentation of skin in both the
legs below the knees.

7. • H/O loss of appetite and weight loss for the
past 10 days after he was admitted
• H/O blood stained urine for the past 20 days
• H/O increased thirst
• H/O gradual loss of sensation in the lower
extremities

8. • No H/O pain
• No H/O giddiness and fainting
• No H/O burning micturition
• No H/O facial puffiness
• No H/O visual disturbances

9. Past History
• He is known DIABETIC for the past 25 YEARS. It was
diagnosed at a camp in his locality. He has been
taking oral hypoglycemic drug for the past 25 years.
Tab. Metformin 500 mg BD
• He was switched to insulin after he got admitted in
TVMCH

10. • He is a known HYPERTENSIVE for the past 10
YEARS and he is on regular treatment with
Tab. Enalapril 5mg BD
• No H/O Bronchial Asthma or TB

11. Personal History
• Not an alcoholic
• He was a smoker upto 50 years of age
• Vegetarian

12. Family History
• His MOTHER and BROTHER were a known
DIABETIC
DIABETIC

13. Nutritional History
FOOD QUANTITY CALORIE PROTIEN
BREAK FAST Idli
Sambhar
1
1 cup
100 Kcal
110 Kcal
1 g
11.1 g
MID MORNING -
LUNCH Rice
Sambhar
1 cup
1 cup
110 Kcal
110 Kcal
4.2 g
11.1 g
EVENING-SNACKS -
DINNER Dosa
Sambhar
2
1 cup
300 Kcal
110 KCal
2 g
11.1 g

14. ACTUAL INTAKE RECOMMENDED
(For diabetics)
DEFICIT/EXCESS
CALORIE INTAKE 840 KCal 1800 KCal 960 Kcal deficient
PROTIEN INTAKE 40.5 g 50 g 9.5 g deficient
SALT INTAKE : 6.5 G/DAY
VEGETARIAN

15. Socio Economic History
NAME AGE SEX RELATION EDUCATION OCCUPATION INCOME
LAKSHMI
NARAYANAN
70 M HEAD OF
FAMILY
8TH PRIEST 360/DAY
KALA 60 F WIFE 5TH HOUSEWIFE -
SARADHA 23 F DAUGHTER COLLEGE - -
NARMADHA 21 F DAUGHTER COLLEGE - -

16. Socio Economic History
• NUCLEAR FAMILY
• FAMILY INCOME : 10800 PER MONTH
• PER CAPITA INCOME : 2700 PER MONTH
• According to MOD. KUPPUSAMY SCALE (Dec. 2016) he
belongs to a socio economic status of UPPER LOWER CLASS.
Score : 7

17. Environmental History
• Rented pucca house
3 rooms
separate kitchen and latrine
gas stove for cooking
corporation water for drinking
waste disposed in municipality waste bin
adequate ventilation and lighting
• No pets

18. General Examination
• Conscious , oriented , afebrile , moderately
built and nourished , ANEMIC , no cyanosis ,
no clubbing , no generalised
lymphadenopathy , no pedal edema , not
icteric.

19. • Height : 160 cm
• Weight : 50 kg
• BMI = 19.5 kg/sq.m
• BP : 120/90 mmhg
• PR : 85/min
• RR : 15/min
• Hb : 11 mg/dl

20. Local Examination
• Not performed

21. Systemic Examination
• CVS : S1 S2 heard. No murmur
• RS : Normal vesicular breath sounds heard. No
added sounds
• ABDOMEN : Soft , not tender , no organomegaly.
• CNS : No focal neural defects

22. Investigations
• Random , fasting and post prandial Blood
glucose level
• Blood HbA1c level , blood hb , lipid profile
• Renal status , fundus examination
• BT , CT , PT , ECG prior to surgical
management

23. Diagnosis
• 70 year old male of known diabetes for past
25 years with complicated gangrenous non
healing ulcer in dorsum of foot of both the
legs

24. Probable risk Factors
• AGE
• HEREDITARY
• SMOKING

25. Advice
• Regular check up for blood glucose levels and
BP
• Diabetic diet and Sick day management
• Take drugs regularly
• Maintain personal hygiene
• Foot care

26. Prevention
• PRIMARY PREVENTION :
Maintain normal body weight
Adopt healthy nutritious food habits and mild
physical activities
Adequate protien and fibre intake

27. Prevention
IDRS analysis for the daughters
GENETIC COUNSELLING : Educate the
daughters of the patient about Diabetes and
its primordial prevention (like food habits ,
physical activity) and the eugenics if possible.

28. • SECONDARY PREVENTION :
Self care of wounds
No Fast and no Feast
Split meal regimen
Regular drug intake and self examination
Be aware of complications like retinopathy,
neuropathy , gangrene , silent heart attack , CAD

29. Foot Care
• Wash feet everyday.
• Cut toe nails regularly.
• Avoid walking barefoot.
• Check footwears for foreign bodies before use.
• Usage of MCR slippers.
• Do not burst blisters.

30. • TERTIARY PREVENTION :
Disability limitation if possible
Rehabilitation of the patient after therapeutic
disabledness due to management of complications –
physical , mental and social support

31. Primary and Secondary Prevention have
been failed in this patient.
He is in need for Tertiary Prevention

32. Programme
NATIONAL PROGRAM FOR PREVENTION AND
CONTROL OF CANCER , DIABETES , CARDIO
VASCULAR DISORDERS AND STROKE (NPCDCS)