Concluded Case

Type 1 DM ,untreated,Muscle &lipid depletion, result in emaciation.

Mr. X ,30 years old ,T2 DM,diagnosed with Random blood sugar ,measuring in the capillary blood glucose monitoring device of Accu chek performa device.This case was posted a months before in Curofy . He is prescribed insulin of premixed ,bolus basal ,combination of 30/70 ,before pre breakfast and free dinner and plain insulin of before lunch. He reported a month later ,and gained 8 kg weight ,from40 kg to 48 was recorded in the first and second visit respectively. This is purely rural practise of medicine in India ,wherein he is diagnosed with hand held glucometer,not even his urine was screened for ketone due to fund constrain from the patient packet. Then one can imagine of C- Peptide ,GAD antibody, Ultasonogram,MRI for pancreatic stone detection , fasting,post prandial ,pre dinner,post dinner,pre lunch ,post lunch ,random,HbA1c, ECG,CXR,renal function, retinal imaging ,all unreachable for the son of the construction labour. Only hand held glucose monitor saved this guy ,the anabolic hormone of insulin saved this guy. See the photo and difference is visible in this clinical photo .He is 6/feet tall boy of 40 kg ,and muscle wasting were noticed in the first photo and 2 photo revels the result .

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Dear Dr Elumalai Subbarayan, First of all I wholeheartedly congratulate you for the fantastic job you had done with so many odds in the typical rural settings of our Country where we have very meager facilities to diagnose and treat. But in spite of all odds you had treated that patient with your clinical acumen and more commonsense which is highly appreciable. Nothing more could be done even in a corporate set up but for a bill in lakhs of rupees, where in the patient has to sell either his house or farming land. Fantastic job indeed. India needs Doctors like you. Regards and thanks, Dr Sepuri Krishna Mohan
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Dear Dr Elumalai Subbarayan, First of all I wholeheartedly congratulate you for the fantastic job you had done with so many odds in the typical rural settings of our Country where we have very meager facilities to diagnose and treat. But in spite of all odds you had treated that patient with your clinical acumen and more commonsense which is highly appreciable. Nothing more could be done even in a corporate set up but for a bill in lakhs of rupees, where in the patient has to sell either his house or farming land. Fantastic job indeed. India needs Doctors like you. Regards and thanks, Dr Sepuri Krishna Mohan
Thank you doctor
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Done very good job Doctor Elumalai subbarayan. Rural practice is a tough job with out investigations nowadays where most of the people depend on it. Doing justice to the patient is most important with in the limited resources. Once again congratulations doctor.
Thank you doctor
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I am fully agree with Dr.Shivrajji. I am experienced of this dilema anx contraversories after returning from Germany after 12 years.. Very appropriate words Dr Shirsjji has chosen..."Constraints are our assets"..irresective of lackinv in latest researches..
Thank you doctor
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Sir this is where indian doctors differ from Europeans We rely more on empirical and practical approach modern medicine is out of reach in poor and social structure of indians Constraints are our assets
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Good effort Doctor but once must ask for chest X-RAY PA view to ruled out Koch's
Since cough is not there and associated fever it was not imposed on him.Let us watch.Absolute absence of insulin is more of wasting of muscle mass ,its protein are used by the body.So imaciation.Thank you for your right interpretation. Indians the DM and TB are coexisted. You are right.
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Great job Lipid Storage. Increased lipiddeposition in skeletal muscle develops when skeletal fiber FA uptake outpaces FA oxidation. An excessivelipid flux into the skeletal muscle is a factor that influences the accumulation of lipid intermediates, which in turn produces lipotoxic stress
Great work sir. Very appreciable. I would like to know, he was initiated on how many units of 30/70 mixtard in morning and night, and how many units of rapid acting insulin??
20 units of 30/70 premixed before break fast ,and 15 units in the predinner. 12 units of regular insulin for the pre lunch was given ,As weight gains insulin requirements are correspondingly increased.Diet planning also planned .He is under depression, so fluoxitine is added.
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Regards sir Dr S K Mohan for good explanation
A nice case and a good treatment.Thank u Dr.
Thank you doctor
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