Type 1 diabetes

22 YEAR FEMALE WITH UNCONTROLLED TYPE ONE DIABETES MELLITUS 


A 23 yr old female came to opd with 

chief complaints of generalized weakness, headache, giddiness, burning sensation in both upper and lower limbs, since 3months

HISTORY OF PRESENTING ILLNESS-

Giddiness - once or twice a week lasting for 5-10 min , not associated with vomiting, neck pain, blurring of vision.

C/o burning sensation of both upper limbs and lower limbs distal extremities since 3 months

C/o generalised weakness of body,but able to get up from squatting position, able to climb upstairs and down,able to comb hair and mix food, able to get up from bed and roll over the bed.able to hold chappals while walking.

No complaints of fever, vomiting's, nausea, pain abdomen, shortness of breath.

No complaints of altered bladder and bowel habits

When she is of 7 y age, she had fever and fell unconscious and was admitted in hospital, remained in the unconscious state till 3 days and there was detected as diabetes mellitus type 1, from then she is on continuous medication 30 units human mixtard in morning and 25 units in the night. 

 From 3 months back, she is the history of generalised weakness, giddiness she visited outside local hospital found to have high blood sugars( > 500 mg/dl) 

6months back she had a history of bleb formation over the left leg medial aspect and on the right leg which resolved on its own.

 

PAST HISTORY :  

She is detected hypothyroid 6 months back and on medication thyronom 25 mg.

 No HTN, TB, epilepsy, CAD.

 Till her 6 y of age, she has h/0 bed wetting daily.

PERSONAL HISTORY:

Normal sleep pattern

Takes mixed diet

Normal bladder and bowel habits 

FAMILY HISTORY: 

No similar complaints in the family.

 Mother and father have consanguineous marriages.

 


VITALS: 

 Okay Temp: afebrile

  PR: 80bpm

  BP: 130/70 mm hg in supine position

          110/70mmhg in standing position

   RR: 20 cpm

   GRBS : 356mg/dl

   

    GENERAL EXAMINATION:






    No pallor , icterus , cyanosis, clubbing, edema

   CVS: s1s2 heard

    RS: BAE+ NVBS+

    P/A: soft, non tender, bowels sounds heard

    CNS: Higher mental functions intact

     Gcs - 15/15

    Cranial nerves - intact

    Motor system- normal

    Sensory system-         Rt            Lt

   Joint sense-             Present      Present

  Vibration  sense-     Present but reduced on both sides up to knee.

Fine touch-             Intact            Intact

Crude touch-          Intact             Intact

Temperature-         Intact             Intact

Cerebellum examination-  intact

PROVISIONAL DIAGNOSIS :

Type 1 diabetes mellitus with uncontrolled sugars with hypothyroidism.

INVESTIGATION:







 BLOOD INVESTIGATION:

Blood Urea - 60mg/dl

Serum Creatinine - 1.4mg/dl

Serum electrolytes(Na,K,Cl)

Sodium-140mEq/L

Potassium- 4.1mEq/L

Chloride- 92mEq/L

Serum protein- 6.3g/dl

Complete urine examination (CUE)

Albumin- Trace

Sugars- 4+

Pus cells-  3-4

Epithelial cells-  2-3

Urine for ketone bodies-  negative




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