Concluded Case

Plantar Abscess in a DM T2 patient .

Here is the patient ,who came for ,Diabetic foot abscess ,,Right sole ,provoked by thorn prick,.She is middle aged woman,agricultural labourer ,socioeconomicaly weaker section. She was treated with antibiotics, premixed insulin,Bid,and daily dressing. The only investigation, Blood sugar fasting and post prandial ,was carried out.She was submitted for weekly blood sugar monitoring ,considering her low income ,and poverty .None other investigation was carried out due to obvious reason. In rural India ,and diabetes presentation in the rural packet is really pathetic.The disease is not sparing any one ,due to changing life style ,and the food habits and the stress, are identical in this days ,both in urban and in rural. The glycemic phenotype in this woman is stress.She is widow ,only daughter who supported her,Stress ,distress ,dysfunction, and disease is the the vicious cycle that induced the diabetes in this rural woman. No h/o genetically predisposition. Not obese,,at her 40 ,the loneliness ,poverty ,depression, stress played a havoc. Beware of stress . Urban and rurals are identical in the NCD patterns,once it was rarely reported in rurals ,but these days non communicable disease like Metabolic disorders of diabetes is common in both set ups. comments are expected .

(Edited)

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Concluded answer
Urban was ,once considered as worst stress induced zone in the development of diabetes. Identical twins born during pre independence ,one who lived in Metropolitan town ,had face high stress during his sixties was prone for diabetes .His Cohort ,who lived in Rural not had developed the disease. Now the ,NCD pattern is changing ,is just because stress is become universal in all land scape due to pressure mounting upon every individual due to high population explosion. DM is a disease of multifactorial ,so it's prevention is the need ,we should know how to monitor our attitude is the basic need of every individual.
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It is really important that unnecessary investigations should be discouraged in poor people who don't have enough money for medicines .What ever little they have they spend on investigations and when it comes to treatment particularly Diabetes, hypertension, hypothyroidism , IHD ,they don't have enough money to continue medications .In this regard I am very critical of Hba1c which is futile in poor patients. Similarly whole lipid profile test can be dispensed with only LDL , VlDL cholesterol and triglycerides. Similarly inKFT - only urea and creatinine are important instead of complete KFT Also complete LFT can be dispensed with only Total S.Bilirubin, SGOT and if required Alkaline phosphatase. We should change our attitude towards poor patients and also write cheaper medications particularly by systolic, FDC , mankind, bluecross Pharma . Thanks Dr Elumalai for initiating a discussion on patient friendly topic than on doctor friendly topic. There are enough rich people- from where you can earn but knowingly doing injustice to poor patients is a crime which can't be pardoned off THANKS
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In such cases looking into the poverty & inability in obtaining medical aid due to penury, large heartedly on humanitarian grounds they should generously provided financial aid to sustain life,which is a service to the Almighty God who created all of us.
Before treating this diabetic ulcer One should aggressive n strict control of blood sugar first
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Excellent Job with Sympathy
Urban was ,once considered as worst stress induced zone in the development of diabetes. Identical twins born during pre independence ,one who lived in Metropolitan town ,had face high stress during his sixties was prone for diabetes .His Cohort ,who lived in Rural not had developed the disease. Now the ,NCD pattern is changing ,is just because stress is become universal in all land scape due to pressure mounting upon every individual due to high population explosion. DM is a disease of multifactorial ,so it's prevention is the need ,we should know how to monitor our attitude is the basic need of every individual.
Diabetes must be controlled to normacy...than only any exercise would be meaningful. Any way your merciful efforts is appreciable. You are quite young...dr..i recall Mother Terssa started such kindness in your age.. May god bless you Dr.Jayeshji.
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Well done sir You have done an excellent Job All of us come across patients who are vet poor It is very important to treat them considering their finances , yet use ideas to make them all right You have helped the very poor Thank you
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Strict diabetic control & diet restriction,insulin to continue with monitoring FAB & pp.dry dressing.
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Absolutely splendid achievement.
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