Prepared by-






Dr.Md.Salim Al Mamun


CMU(DU); DMUD(Course)

ID – 902298

RTC – 10

Contact no. 01721463398




Diabetes mellitus,a chronic & debilitating disease is associated with a range of severe complications namely cardiovascular disease,renal disease&blindness.Diabetes mellitus is a metabolic disorder resulting in raised blood glucose (hyperglycemia) from defects in insulin secretion,insulin action or both that arise from genetic as well as environmental factors.It is defined by documenting raised blood glucose in fasting state (≥7.0 mmole/L) or 2 hours after an oral standard glucose drink (≥11.1 mmole/L).Epidemiological evidences suggest that the incidence of diabetes is increasing worldwide.The present prevalence rate of diabetes in the world among the people of 20-79 years of age is 5.9%.Now diabetes mellitus in people of all ages is reaching epidemic proportions in Bangladesh.In some sector of society,more than 10% of people have diabetes.The good news is that secondary & tertiary preventions are now highly effective.Secondary prevention includes screening,modification of diet,adopting a healthy lifestyle&increse physical activity.Tertiary prevention includes proper clinical management of the patient’s condition,for example to prevent blindness in diabetic retinopathy.To a large extent,even primary prevention is possible&includes such measures as dietary&exercise advice.



Chronological description of the development of diabetes of Mrs.Tahmina:

Mrs.Tahmina aged 46 house wife came from a village of Dinajpur.While staying in village she used to walk at least one hour a day on her way to school and college.But after her marriage with a businessman, her lifestyle become changed.Her physical activity reduced , habituate with frequent rich meal and at a stage of her life she become diabetic.Early few years of diabetes she take medication accordingly with regular follow up.Then discontinued her treatment.Later on when she went to dentist she has been diagnosed as highly uncontrolled DM with hypertention and renal failure.


Presenting features of type 2 Diabetes Mellitus:

In type 2 diabetes mellitus & other forms of diabetes mellitus,presentation may remain asymptomatic for quite a long period after the onset of diabetes.In practice about 20% cases of type 2 diabetes present with one or more features related to diabetic complications such as micro and macro angiopathies.

Typical features of diabetes mellitus:

Typical features start with glycosuria,which means loss of glucose in urine ,that begins after the blood glucose level has gone above the individuals renal threshold for glucose.

Features include


– Polydipsia

– Polyphagia

-Weight loss

-General weakness

Atypical manifestations are non-specific.A short list includes:

– Non-healing infection

– Infertility or repeated pregnancy loss

– Undue fatiguability

– Pruritus vulvae etc.


– Diabetic retinopathy

– Diabetic nephropathy

– Diabetic neuropathy


– Cardio vascular disease

– Cerebro vascular disease

– Peripheral vascular disease

In this case Mrs.Tahmina came with profound general weakness for about 2 months.


Risk factors of development of Diabetes mellitus:

Risk factors are as follows –

A.Genetic susceptibility

B.Environmental risk factors

Change in diet

– Obesity

– Physical inactivity

In this case –

Mrs.Tahmina came from a diabetic family as for example one of her brother is recently diagnosed as diabetic and hypertention.


Her BMI is  –

Weight in Kg/(Height x Height) in metre

=76/(1.57×1.57) Kg/m²

=30.83 Kg/m²

So she is catagorised as obese.

She also has history of taking frequently rich foods.She is also hypertensive and H/O physical inactivity at present.

Modification of lifestyle:

Diabetes mellitus is a life long disorder.Type 2 DM is more complex disorder and here lifestyle modifications/interventions has the potentiality to correct some of factors which are not only proven as risk factors for developing diabetes but also to cause deterioration in glycemic status of the individual.

Lifestyle modification includes-

– Modification in diet habits.

-Adaptation to regular physical activity

-Take part in monitoring treatment outcome.

                        Target of glycemic and lipid control
Blood glucose Fasting<6.1mmole/L


Bed time<7.0mmole/LHbA1c<7.0%Lipid profileLDL<100mg/dl


TG<150mg/dl                   Target of body weightBMI<25 Kg/m²                           Target of diabetic educationPatientTeaching,training and empowerment to take part in treatment.




Plan of Drug treatment and follow up:

This is a case of highly uncontrolled blood glucose with renal failure and hypertension.

So my treatment option will be treatment of –

1.Diabetes Mellitus

A. Non pharmacological

-Lifestyle modification



B. Pharmacological

I like to withdraw Tab.Metformin due to renal impairment and Gliclazide with maximum dosage , then if not respond then i like to give insulin.Pioglitazone may be given.

2.For renal failure and hypertention 

I like to add ACEI and Aspirin

3.Lastly i want to do Lipid profile, ECG& Neurological examination and if i find any abnormality then i want to treat accordingly.


Diabetes is a life long disease.Diabetes itself is not so dangerous but it’s complications may endangers life.So with proper controlling of blood glucose and lifestyle modifications with regular follow up a diabetic person can enjoy a healthy,joyful and colorful life without hampering his or her day to day usual activities.

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