Daibetic Type 1 or 2

28/f from rural, having weight loss since 1 yr, Now 37kg, excessive hunger, increase urine output. Cough, no fever. No family history, 1 sister among 4 brother, no parents DM history. C peptide random send Plz suggest management Chief Complaints Weight loss Increase urine frequency History No any family history, 1 sister among 4 brother No parents DM history

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In the times of COVID-19 along with a probably viral blood picture, it make me suspicious of COVID-19 induced hyperglycemia. Sorry I may have gone far beyond. Considering weight loss from last 1 year along with cardinal symptoms of polyuria, polyphagia, she could be a case of T2DM, which is usually these days young onset. Usually parents before never got themselves checked for DM. They might have had mild hyperglycemia, but no one cared that time. Anyways, lets wait for C peptide report. Furthermore, there is another entity MODY, for which we need a expert endocrinologist to give his/her view, if she could be a case of MODY. DKA is ruled out too, as ketone bodies are negative too. Considering pus cells elevated, leucocytes present with only urinary frequency increased, you have the option to start him on oral abs. As there are no symptoms of fever, flank pain, costovertebral angle tenderness etc, so its not a case of complicated UTI. Treat him by Levofloxacin 750mg OD for 10 days, or uptil urine culture becomes available. In injectables you can give him Piperacillin/Tazobactum 4.5 BD or TDS along with Levoflox 100ml OD, but I think oral Abs will suffice. Counsel him for insulins as it is need of the hour. Either mixtard 30/70 breakfast and dinner or a basal bolus regimen. Also can give papaya extracts tablets for platelets along with IV Fluids. Please advise her the following tests - HbA1C USG KUB Urine CS

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Thanks for tagging me Dr Robin Nirwan. This is a case of Insulin requiring DM with urinary tract infection. Order for following investigations. CBP FPG and PPG HbA1C RFT LFT Serum electrolytes Fasting lipid profile TFT Serum C peptide GAD antibodies,IAA and ICA antibodies in a good lab to decide whether it is Type 1 DM or Type 2 DM. Micralbuminuria CUE Urine culture and sensitivity. Rule out ketone bodies Chest X ray to rule out tuberculosis . ECG 2 D Echo USG abdomen to rule out pancreatic abnormalities and tumors and pyelonephritis. Finally Covid test RTPCR to rule out Covid 19 in this pandemic. Coming to the treatment, Advice her admission. If Patient refused to get admitted, Start with basal bolus regimen in case of DKA or premixed biphasic human insulin in non DKA case. Correct serum electrolyte s. Advice her to take plenty of oral fluids . Give her a course of antibiotics for UTI . With in 48 to 72 hours of Insulin initiation , her symptoms will improve like excessive hunger will decrease, urinary frequency will come down. Treat if there is associated pulmonary koch's. LSM and TLC after she gained weight and recovered.

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It is a case of T2DM as age of presentation is 28 years and weight loss is since last one year . A random blood sugar of 687 is too high . He needs urgent admission in intensive care setting as he may go to hyperosmolar non -ketotic Coma or diabetic ketoacidosis . Management includes- a fasting blood sugar testing , urine for ketone bodies. Insulin as bolus 5 units stat IV - and then in drip, maintaining dehydration with urine output by an indwelling catheter .Glucagon and Potassium in drip is also required with frequent hourly Blood sugar and Potassium monitoring

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Uncontrolled and non serious patient of T2DM Reassurance and counciling required. Strict control of bSL by medicine, and change in life style. Pt needs regular monitoring and constant evaluation plus treatment and evaluation and assessment of multiple organs are effected or damaged during this period and line of action. Under present circumstances covid 19 test may also be carried out with other investigation.

Thanks Dr Shivraj Agarwal
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POSSIBLY... MEDICATIONS. INDUCED UNCONTROLLED HYPERGLYCEMIA AND THROMBOCYTOPENIA... ADVISABLE 1. BLOOD. AND. URINE....C ) S 2. USG.....CHEST. AND. WHOLE. ABDOMEN 3. ECG .......ECHO 4. EVALUATION. OF. DRUG. HISTORY

Very high BSLR 689.1mg H/o polyurea and wt loss This is a c/o DM2T Need to be evaluated further f&pp hba1c Also adv TFT Usg abdomen and ecg Screen sr cholestrol and lipid profile

Thanx dr Ashok Leel
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रोगी मधुमेह जनित यकृतशोथ से पीड़ित है। चिकित्सा,,, प्रथम रोगी की मधुमेह को नियंत्रित करें इस के लिए,,, बसंत कुसुमाकर रस 1 रत्ती सत गिलोय 4 रत्ती शहद में मिलाकर सुबह-शाम सेवन कराएं। रोगी को मीठा नहीं खाना चाहिए। यकृत दारी लौह 4 रत्ती ताप्तयादि लौह 4 रत्ती शहद में मिलाकर सुबह-शाम सेवन कराएं। ताजा गिलोय का काढ़ा बनाकर उसमें 2 ग्राम भूमी आमला का चूर्ण मिलाकर सुबह-शाम सेवन कराएं। योग परिक्षित है। पिछले 40 वर्ष से प्रयोग कर रहा हूं।

Very high Sugars are seen in initial presentation of T2 DM also. Though S Acetone is indicated. Needs to start with Basal and Bolus insulin therapy. Control secondary issues and rule out COVID illness also. High dose of Folic acid is also needed here. Ruleout ITP.

This is a case of type2 DM Advise admission n insulin drip n every hourly cbg To do:urine acetone Urine culture Lipid profile Tsh Electrolytes Usg abd.

Diabetes do fbs ppbs hb1 ac Uti do urine culture and sensitivity DD pituitary tumor keep in mind Diabetes wt loss known Frequency is UTI

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