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COMPREHENSIVE
CLINICAL CASE
ANALYSIS OF DIABETES
MELLITUS:
IMPLICATIONS FOR
DIAGNOSIS AND
MANAGEMENT
HOSTS
DEWAN MASUDUR RAHMAN SHESADRY SANYAL RAKTIMA
ROLL : 41 ROLL : 45
NUSRAT MARIA MAHI NUR SATHI

ROLL : 42 ROLL : 46
TASFIA TARANNUM TONDRA JANNATUL PREMA
ROLL : 43 ROLL : 47
MD. ANWARUL AZIM SARKER MD. SAZZADUL HASAN

ROLL : 44 ROLL : 48
PATIENT DEMOGRAPHY
Name : SAROWAR HOSSAIN
Sex : Male
Age : 53
Address : Saturia , Manikganj
Occupation : Teacher
Socioeconomic Status : Middle-class
Marital status : Married
Ward : Male Medicine
Bed No : 13
Date of Admission : 01-09-2024
Date of Examination : 09-09-2024
CHIEF COMPLAINTS
• Increased frequency of micturition for 1

month
• Increased thirst for 1 month
• Ulceration of foot for 15 days
HISTORY OF PRESENT ILLNESS
According to the statement of patient he was reasonably well one
month back . Then he has been suffering from increased
frequency of micturition & passage of large volume of urine for 1
month.The frequency of micturition was 10-12 times a day. It was
clear & transparent in color. It was associated with burning
sensation. He also complaints of waking up to void at night. It
associated with excess thirst for 1 month for which he has to take
plenty of water . He has also complain about ulceration of foot
which has started 15 days back . The ulcer is in the great toe , sole
of the foot having the size of 2. 5×2 cm & the ulcer is
characterised by regular margin, punched out edge & black in
color. He has no history of abdominal pain,night
sweat,diarrhoea,vomiting & abnormal bowel habit.
HISTORY OF PAST ILLNESS
He had no significant medical admission or surgical history.
He had no contact with smear positive TB patient.
DRUG HISTORY
He has no significant drug history.

FAMILY HISTORY
He lives with his wife and son. All of them are healthy . But
his mother was diabetic for 25 years.
SOCIO-ECONOMIC HISTORY
He belongs to a middle class family. He lives in a tin shed house and

drinks water from deep-tubewell and has a good sanitary system.
IMMUNIZATION HISTORY
He is immunized with BCG vaccine and 3 doses of corona

vaccine .
HISTORY OF ALLERGY
Patient is not allergic to any kind of food and

dust.
EXPOSURE HISTORY
Patient is a happily married man and has no history
of having multiple sexual partners.
GENERAL EXAMINATION
• Appearance : Ill-looking • Leukonychia : Absent
• Body-built : Average • Lymph Node : Not Palpable
• Co-operative : Patient is co-operative • Thyroid Gland :Not Palpable
• Decubitus : On-choice • Skin Condition : Normal
• Anemia : Absent • Hair Distribution : Normal
• Jaundice : Absent • JVP : Not raised
• Cyanosis : Absent • Vital Signs :
• Dehydration : Absent Blood Pressure :130/90 mmHg
• Oedema : Absent Pulse : 76 bpm
• Clubbing : Absent Respiratory Rate :16 breaths/min
• Koilonychia : Absent Temperature :98.5℉
SYSTEMIC EXAMINATION
• Respiratory System : No Abnormalities Found

• Cardiovascular System : No Abnormalities Found
• Alimentary System : No Abnormalities Found
• Nervous system : No Abnormalities Found
SALIENT FEATURE
Mr. Sarowar Hossain, a 53 years old, married muslim male teacher,
non- smoker, non-alcoholic, hailing from Saturia , Manikganj, has been
admitted to Manikganj Medical College Hospital on 1st
September,2024 with the complain of Polyuria and polydipsia for last
1 month.The color of urine is clear & transparent .It is associated with
nocturia. He also complained about ulceration of foot for 15 days. It is
multiple necrotic debris . The patient is non asthmatic ,normostensive
& his bowel habit is normal.His mother was diabetic for 25 years.
General examination reveals no abnormalities with blood pressure
130/90 mmHg, pulse 75 bpm, respiratory rate16 breaths/min,
temperature 98.5℉.
Other systemic examination reveals no abnormalities.
PROVISIONAL DIAGNOSIS
• Type-2 diabetes mellitus

DIFFERENTIAL DIAGNOSIS
• Stressed hyperglycemia
• UTI in male
INVESTIGATION
 RBS
 CBC with ESR
 FBS
 OGTT
 Lipid Profile
 Urine RME
 Serum Creatinine
 C Peptide
INVESTIGATION
Hematological Report
Test Name Result Test Name Result
Haemoglobin 15 g/dl Monocytes 06%
40 mm in 1st
ESR Eosinophils 02 %
hour
Total Count Basophils 00%
Total RBC Count Red cell indices
Total WBC count 5.2 million/ uL MCV 85.7 fL
Total Platelet
3,50,000 /cumm MCH 28.2 pg
Count
Differential Count MCHC 32.9 g/dl
Neutrophils 64% HCT 32.8%
Lymphocytes 30%
INVESTIGATION
Biochemical Test Report
Test Name Result
Random Blood Suger 15 mmol/l
2 Hour After 75 gm Glucose 20.5 mmol/l
Serum Creatinine 0.8 mg/dl
SGPT/ ALT 38 U/L
Total Cholesterol 180 mg/dl
HDL Cholesterol 41 mg/dl
LDL Cholesterol 72 mg/dl
Serum Triglyceride 135 mg/dl
INVESTIGATION
Urine Examination Report
Physical Examination
Colour Straw
Appearance Clear
Sediment Nil
Chemical Examination
Reaction Acidic
Excess of Phosphate Nil
Albumin Nil
Sugar (++)
Microscopic
Pus Cell 2-4/ HPF
Epithelial Cell 1-5/ HPF
Red Blood Cell (RBC) Nil/ HPF
CONFIRMATORY DIAGNOSIS
• Type-2 diabetes mellitus

TREATMENT PLAN
Diet:
• Patient Should not skip three major meal
• Daily CHO intake must be reduced
• Avoid refine sugar & take fiber
containing foods
• Patient should take small amount of
snack between meal
Discipline:
• Regular exercise
• Avoid smoking
• Avoid sedentary lifestyle
TREATMENT PLAN
Drugs:
• Tab METFORMIN
1+0+1 ( cont.)
• INJ. S/C INSULIN
15 mins before meal after measuring the blood sugar
for 7 days.
• Cap. FLUCLOXACILLIN 500 mg
1+1+1+1 (10 days)
• Cap OMEPRAZOLE 20 mg
1+0+1 before meal (1 month)
OUTCOME OF THE GIVEN TREATMENT
Days Pulse Blood Resp. Temp. Body Urine Blood
(BPM) pressure rate weight (ml) glucose
(mm Hg) (breaths (kg) (mmol/l)
/ min)
D1 80 130/90 17 98.5 64 2700 15
D2 80 130/90 20 98.5 64 2700 14.8
D3 80 120/85 18 98.5 64 2500 13.3
D4 78 120/80 17 98.5 64 2200 12.7
D5 78 130/80 18 98.5 64 2000 12.2
D6 78 130/90 18 98.5 64 2000 11.8
D7 80 130/80 18 98.5 64 1600 11.3
ADVICE
• Patient should take meal within 30 minutes of taking insulin
• He should carry something sweet with him all the time
• He should never skip a meal
• Insulin should be stored in refrigerator
• Patient should be shown right way to take insulin
• Patient should alternate the site of injection periodically
FINAL COMMENT
In our opinion the given treatment was satisfactory. The
patient condition is gradually improving. Thus it is good
prescription. The patient was given proper instructions to
continue medication with required dose & time period.
Advice was given how to manage Type-2 diabetes mellitus. He
was requested to come for follow up after 1 month to check
for improvement of his condition.
ANY QUESTIONS
DISCUSSION ABOUT GIVEN DRUG THERAPY
&
THERAPY PROBLEMS.
• Whether the selection of drug was appropriate or not?
Explain.
Selection of the drug was appropriate because benefit of given
drug was more than the risk , cost was reasonable.
• For the given drug, are there other alterntives?
Yes other alternatives include:
DISCUSSION ABOUT GIVEN DRUG THERAPY
&
THERAPEUTIC PROBLEMS
Is there any therapeutic problem of the case?
→Yes. There are some therapeutic problems. eg; nausea , abdominal
discomfort, diarrhea , lactic acidosis.

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COMPREHENSIVE

NUSRAT MARIA MAHI NUR SATHI

MD. ANWARUL AZIM SARKER MD. SAZZADUL HASAN

• Increased frequency of micturition for 1

He has no significant drug history.

He belongs to a middle class family. He lives in a tin shed house and

He is immunized with BCG vaccine and 3 doses of corona

Patient is not allergic to any kind of food and

• Respiratory System : No Abnormalities Found

• Type-2 diabetes mellitus

• Type-2 diabetes mellitus

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