CASE PRESENTATION ON

DIABETES MELLITUS

HAJIRA SAMREENOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
23Q0040
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GAUTHAM COLLEGE OF PHARMACY OOOOOOOOOOOOOOO
BENGALURUO OOOO
OOOOOOOOOOOOOOOOOOOOOOOOOO
PATIENT DEMOGRAPHICS
• NAME : Mr. XYZ
• AGE/SEX : 45 Years/Male
• IP NO. : 5023440110
• HEIGHT : 1.57m²
• WIEGHT : 50kg
• BMI : 20.3kg/m
• DATE OF ADMISSION : 08/12/2024
• DATE OF DISCHARGE : 13/12/2024
• UNIT/DEPARTMENT : 7th, General ward
SUBJECTIVE EVIDENCE
CURRENT COMPLAINTS AND HISTORY OF PRESENTING
ILLINESS :
• c/o chest pain and chest burning since 2 weeks.
• H/o chest pain and burning sensation from 2 weeks , after
food.
PAST MEDICAL HISTORY :
• K/C/O type 2 Diabetes Mellitus from 4 years.
SUBJECTIVE EVIDENCES
PAST SURGICAL HISTORY :
• Nothing significant
PAST MEDICATION HISTORY :
• Glycomet GP1 (Metformin HCL 500mg + Glimepride)
FOOD AND DRUG ALLERGY :
• Nothing significant
FAMILY HISTORY :
• Nothing significant
OBJECTIVE EVIDENCE
PHYSICAL EXAMINATION :
• A 45 years old male patient was moderately built , and nourished. He
was conscious, co-operative and alert.
VITAL EXAMINATION :
VITAL SIGNS NORMAL RANGE TEST VALUE
TEMPERATURE 98.6°F 98.6°F
BLOOD PRESSURE 90/60-120/80 mmHg 122/81 mmHg
PLUSE RATE 60-100 bpm 82 bpm
RESPIRATORY RATE 12-20 cpm 20 cpm
SpO2 97-100% 94%

P I C C L E
- - - - - -
OBJECTIVE EVIDENCE
SYSTEMIC EXAMINATION :
• CVS : S1,S2 heard.
• CNS : NAD.
• RS : NVBS heard.
• P/A : Soft , non-tender , no organomegaly.
PROVISIONAL DIAGNOSIS :
• Diabetes Mellitus , Gastritis .
 LABORATORY INVESTIGATIONS
SL. NO. TEST NORMAL VALUES OBSERVED VALUES
HEMATOLOGY
1 Hb M:13.5-18.0 g/dL 11.3 g/dL
F:11.5-16.9 g/dL
2 TC 4K-11K cells/mm³ 8900 cells/mm³
3 Platelet Count 1.40-4.40 lakh cells/mm³ 4.0 lakh cells/mm³
4 Neutrophils 40.0-75.0% 72%
5 Lymphocytes 20-45% 20%
6 Eosinophils 1-6% 2%

7 Monocytes 1-10% 6%
8 FBS 75-115 mg/dL 152 mg/dL
9 PPBS 70-140 MG/dL 296 mg/dL
10 HbA1C 4.5-6.3% 12.1 mg/dL
 LABORATORY INVESTIGATIONS
SL. NO. TEST NORMAL VALUE OBSERVED VALUES
KIDNEY FUNCTION TEST
11 Blood Urea M : 19.26-42.8 mg/dL 27 mg/dL
F : 14.98-36.38 mg/dL
12 Serum Creatinine M : 0.66-1.25 mg/dL 0.9 mg/dL
F : 0.5-1.04 mg/dL
URINE ANALYSIS
13 Sugar Nil 0.5%
LIVER FUNCTION TEST
14 Tot.Bilirubin 0.2-1.3 mg/dL 0.8 mg/dL
15 Direct Bilirubin 0.1-0.3 mg/dL 0.1 mg/dL
16 Tot.Protein 6.3-8.2 g/dL 6.5 g/dL
17 Serum.Albumin 3.5-5.0 g/dL 4.2 g/dL

18 SGOT (AST) M : 17-59 U/L 30 U/L

F : 14-36 U/L
19 SGPT (ALT) M : <50 U/L 33 U/L
F : <35 U/L
20 ALP 38-126 U/L 140 U/L
 OBJECTIVE EVIDENCE
RADIOGRAPHIC DATA / OTHER DIAGNOSTIC TESTS
• Chest X-RAY – Pulmonary KOCH’S
• U/S Abdomen and Pelvis – No significant sonological Abnormalities.
 ASSESSMENT
From the objective and subjective , the patient is diagnosed with
SUBJECTIVE EVIDENCE OBJECTIVE EVIDENCE ASSESSMENT
• CHIEF COMPLAINTS :
c/o chest pain and chest Chest X-RAY-PULMONARY KOCH’S Old PTB (Pulmonary tuberculosis)
burning since 2 weeks . [suspect]
• HISTORY OF PRESENTING OF
ILLNESS (HPI) : • FBS : 152 mg/dL Diabetes Mellitus (Uncontrolled).
h/o chest pain and burning • PPBS : 296 mg/dL
sensation from 2 weeks , after • HbA1C : 12.1 mg/dL
food.
• PAST MEDICAL HISTORY :
K/C/O Type 2 diabetes mellitus
from 4 years .
• PAST MEDICATION HISTORY :
T. Glycomet GP1 ( Metformin HCL
PR + Glymepiride ) 500/1 mg
[Since 4 years]
 GOALS OF THERAPY
DIABETES MELLITUS
o The primary goals of DM management are to reduce the risk for microvascular
and macrovascular disease complications.
o To ameliorate symptoms , to reduce mortality and to improve quality of life.
o Reducing the potential for microvascular complications is targeted at adherence
to therapeutic lifestyle intervention. [i.e., diet and exercise programs]
o Drug-therapy regimens , as well as at maintain blood pressure as near normal as
possible.
o Appropriate care requires goal setting for glycemia , blood pressure , and lipid
levels , regular monitoring for complications dietary and exercise modifications ,
medications , appropriate self-monitored blood glucose (SMBG) , and laboratory
assessment of the aforementioned parameters. Glucose control alone does not
sufficiently reduced the risk of macrovascular complications in persons with
Diabetes Mellitus .
o NORMAL BLOOD SUGAR LEVELS , TARGETING :
FBS : <115 mg/dL PPBS : ≤170 mg/dL .
 C U R R E N T M E D I C AT I O N
BRAND NAME GENERIC NAME DOSE FREQ. ROA D1 D2 D3 D4 D5 D6
Inj. Taxim Cefotaxime Sodium 1000 mg 1-0-1 IV + + + + + +
T. Azee Azithromycin 500 mg 0-0-1 P/O + + + + + +
Duolin Ipratropium Bromide 3 ml 1-0-1 NEB + + + + + +
and levosalbutamol
Respirator.
Budecort Budesonide Nebuliser 1 mg 1-0-1 NEB + + + + + +
T. Montek LC Montelukast Sodium and 10 mg 1-0-1 P/O + + + + + +
Levocetrizine HCL
NOVOmix Biphasic Insulin 30/70 1-0-1 SC + + + + + +
T. Glycomet Metformin HCL PR 500/1 mg 1-0-1 P/O + + + + + +
GP-1 +Glimepride
T. Pan Pantoprazole 40 mg 1-0-1 P/O + + + + + +
IVF – NS Sodium Chloride 2 pints 75 IV + + + - - -
injection ml/hr

T. Vit.BC B-complex 1mg 1-0-1 P/o + + + + + +

 CLINICAL PROGRESS
Patient got admitted on 08/02/2024 to 7th ward general medicine :
DAY 1 (08/12/2024)
Temp PR RR BP SpO2
NORMAL 90 bpm 20 cpm 120/78 mmHg 96%

 Drugs given : IVF-NS- connected 75ml/hr, NOVOmix insulin,

nebulization,Inj.cefotaxime sodium, all oral drugs given.
DAY 2 (09/12/2024)
Temp PR RR BP SpO2
NORMAL 96 bpm 20 cpm 125/79 mmHg 94%
 Drugs given: IVF-NS connected, insulin, nebulization, inj.cefotaxime sodium,
oral drugs.
 CLINICAL PROGRESS
DAY 3 (10/12/2024)
 Temp PR RR BP SpO2
NORMAL 94 bpm 20 cpm 125/70 mmHg 95%

 Drugs given: IV-NS connected, insulin, nebulization, inj. Cefotaxime sodium,

oral durgs given.
DAY 4 (11/12/2024)
Temp PR RR BP Spo2
Normal 94bpm 21 cpm 120/80 mmHg 90%

 Drugs given: Inj. Cefotaxime sodium and all oral drugs given.
 CLINICAL PROGRESS
DAY 5 (12/12/2024)
 Temp PR RR BP SpO2
NORMAL 95 bpm 20 cpm 118/82mmHg 92%

 Drugs given : Inj. Cefotaxime sodium and all oral medications.

DAY 6 (13/12/2024)
Temp PR RR BP
NORMAL 90 bpm 20 cpm 120/70 mmHg

 Drugs given: Inj. Cefotaxime sodium and all oral drugs given.
DISCHARGE MEDICATION
BRAND NAME GENERIC NAME DOSE FREQ. DURATION
Tab. Glycomet GP1 Metformin HCL PR + 500/1 mg 1-0-1 90 Days
Glimepiride
Tab. Montek LC Montelukast Sodium 10/5 mg 0-0-1 30 Days
+ levocetirizine HCL
Cap. Omez Omeprazole 20 mg 1-0-0 30 Days
Cough Syrup Ambroxol, 100 ml 1-0-1 10 Days
Ambrolite Terbutaline,Guaiphe
nesin and menthol
Tab. Volixm Voglibose and 2/500 mg 0-0-1 60 Days
metformin HCL

Cap. Vit.BC B-complex 0-1-0 30 Days

PHARMACIST INTERVENTION
No drug-drug interaction is found in the prescribed medication.
Drugs which are prescribed are rationalized.

REFERENCE
Stockleys drug interaction book.
CEFTAXIME
CLASS cephalosporin antibiotic
ADR The most frequent adverse
reactions are :
Local (4.3%) - Injection site
inflammation with IV
administration.
Hypersensitivity (2.4%) - Rash,
pruritus, fever, eosinophilia.
Gastrointestinal (1.4%) - Colitis,
diarrhea, nausea, and vomiting
have been reported rarely.

INCICATION indicated for the treatment of

patients with serious infections
caused by susceptiblestrains of the
designated microorganisms.

MONITORING PARAMETER Antibiotic- Indicated in the

treatment of patients with serious
infections.
 AZITHROMYCIN
CLASS Macrolide antibacterial
ADR Most common adverse reactions are diarrhea (5 to
14%), nausea (3 to 18%),
abdominal pain (3 to 7%), or vomiting (2 to 7%).
(6.1)

INDICATION indicated for mild to moderate

infections caused by designated, susceptible
bacteria:
• Acute bacterial exacerbations of chronic
bronchitis in adults (1.1)
• Uncomplicated skin and skin structure infections
in adults (1.1)
• Urethritis and cervicitis in adults (1.1)
• Genital ulcer disease in men (1.1)

MONITORING PARAMETER For the treatment in uncomplicated multidrug

resistant enteric fever only.
 BUDESONIDE
CLASS Anti-asthematic medication
ADR Most common adverse reactions are Headache,
nausea,
upper abdominal pain, fatigue, flatulence,
abdominal
distension, acne, urinary tract infection, and
constipation.
INDICATION Budesonide is a glucocorticosteroid indicated
for the induction of
remission in patients with active, mild to
moderate ulcerative colitis.
MONITORING PARAMETER For the treatment of asthma where the use of
corticosteroid and long acting beta agonist in
combination is appropriate.
 METFORMIN HYDROCHLORIDE+
GLIMEPRIDE

CLASS Sulphonylureas, biguanides

ADR Hypoglycemia, headache, nausea, and

dizziness.

INDICATION Adjunct to diet and exercise to improve

glycemic control in adults with type 2
diabetes mellitus.

MONITORING PARAMETERS Blood glucose levels.

 PANTOPRAZOLE
CLASS Proton-pump inhibitor

ADR Headache, diarrhoea, nausea, abdominal pain,

vomiting, flatulence, dizziness, and arthralgia.

INDICATION Short-Term Treatment of Erosive Esophagitis

Associated with Gastroesophageal Reflux Disease,
Maintenance of Healing of Erosive Esophagitis.
Pathological Hypersecretory Conditions Including
Zollinger Ellison Syndrome

MONITORING Serum gastrin level concentrations, bone loss, serum

PARAMETER magnesium.
 NOVOMIX
CLASS Anti-diabetic drug class

ADR Adverse reactions of insulin therapy

include hypoglycemia,
allergic reactions, local injection site
reactions, lipodystrophy, rash and
Pruritus

INDICATION NOVOLOG MIX 70/30 is a mixture of

insulin aspart protamine, an
intermediate-acting human insulin
analog, and insulin aspart, a rapid-
acting
human insulin analog, indicated to
improve glycemic control in adult
patients
with diabetes mellitus.

MONITORING PARAMETER Blood glucose, Potassium level

 MONTEKLUKAST SODIUM
+ LEVOCITRIZINE
CLASS Antihistamine, leukotriene antagonist
ADR Most common adverse reactions are: upper
respiratory
infection, fever, headache, pharyngitis, cough,
abdominal pain,
diarrhea, otitis media, influenza, rhinorrhea,
sinusitis, otitis
INDICATIONS Prophylaxis and chronic treatment of asthma in
patients 12 months of age and older.
Acute prevention of exercise-induced
bronchoconstriction (EIB) in patients 6 years of
age and older.
Relief of symptoms of allergic rhinitis (AR):
seasonal allergic rhinitis (SAR) in patients 2 years
of age and older, and perennial allergic rhinitis
(PAR) in patients 6 months of age and older
MONITORING PARAMETERS