LOGO A Diabetes Mellitus Case Shen Ji

2 Contents 1. medical record 2. Physical examination and laboratory test 3. diagnosis 4. Treatment 5. Further test

3 1.medical record  A 56-year-old man was brought into the hospital on May, 11,2007. He has a history of polyuria, polydipsia, lassitude and weigh loss during the past ten years.  His illness developed worse with gangrene of the foot 6 months ago. medical record

4 1.medical record  Ten years ago he suffered from polyuria, polydipsia, lassitude and weigh loss under no obvious predisposing causes. He had 4000 ml water per day. His appetite became ravenous and his caloric intake doubled, yet he lost 10 kg within 6 months.

5  Laboratory data fasting plasma glucose 225mg/L, urine protein (++), urine glucose (++++).  He has seen physicians intermittently, and received effective drug treatment and turned better. 1.medical record

6  Up to one year ago he presented with blurred vision. Ophthalmology test showed “mild cataract （白内障）, there were neogenetic blood vessels on his retina.”  About 6 months ago, he injured his right foot, and it has failed to heal.  Current medications were 5 mg glyburide twice a day.

7 1.medical record  He has no past history of allergy to drugs and there are also no special factors about his family history and personal history. medical record

8 1.medical record  His dorsalis pedis( 足背 ) and posterior tibial pulses （胫骨后脉搏） were absent bilaterally （双向地）. The right foot was erythematous （红 斑）, and several toes had areas of dry gangrene （坏疽） (2nd toe, lateral aspects （侧面） of big toe, 5th toe), no tenderness （触痛） and no pus （脓）. Sensation in the right foot was diminished.  Two years ago, he had a femoral-popliteal bypass （股腘动脉旁路术） and removal of two toes.

9  BP 165/105 mmHg  Laboratory data : fasting plasma glucose 237 mg/dl, urine protein (+), urine glucose (+++), BUN 7.0mmol/L. Physical examination and laboratory test 2.Physical examination and laboratory test

10  The patient was educated, taught self- monitoring of blood glucose, instructed in diet, and had his glyburide increased to 10 mg in the morning and 5 mg at night. Treatment

11 3.Diagnosis 1.Type 2 Diabetes : Diagnosis: 2. Moderate hyperpiesia cataract, diabetic foot, Diabetic Nephropathy

12 Key for diagnosis (1) typical symptoms of Type 2 Diabetes (polyuria, polydipsia, polyphagia,weigh loss); His disease is gradual in onset; (2) FPG≥7.0mmol/L; 1. Type 2 Diabetes and complications:

13 Key for diagnosis (4) the right foot failed to heal and several toes had areas of dry gangrene. These are symptoms of both external injury and neuropathy and consistent with diabetic foot. (5) a medical record of diabetes mellitus for 10 years and Proteinuria(+) (3) a medical record of diabetes mellitus for 10 years and cataract

14 Key for diagnosis 2. Moderate hyperpiesia : key His blood pressure is 165/105 mmHg and is higher than normal, no other evience for organ damage.

15 differential diagnosis: 1 Type 1 Diabetes 2 renovascular hypertension 3 nephrotic syndrome

16 1.active treatment for Diabetes: go on a diet, have his glyburide exactly, do exercises properly. 2. symptomatic treatment: treatment for complications of kidney, foot and eyes 3. controllable treatment for hyperpiesia: low salt diet, hypotensive drug treatment 4.treatment

17 5.Further test  urine glucose for 24 hours, urine protein quantitation  saccharifying hemoglobin, insulin, serum C-peptide assay  liver and nephric function examination  ophthalmology examination  serum lipoprotein

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