52F Diabetes 6 years Diabetic Dermopathy Months WB PaJR

 

10-12-2024

This is an Online E Log Book to discuss our patient's de-identified health data shared after taking her signed informed consent . Here we discuss our patient's problems through series of inputs from available global online community experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.

Long distance patient evaluated now in OPD

Diabetes 6 years

370 mg post prandial on screening in Bhuvaneshwar medical college. 

Was on life style modification for 6 months. Repeat pp 170 mg

Started on medicines Tablet Metformin 500mg  twice daily 

Later since 1 year added glimiperide 2 mg at night

Last FBS 96 

PPBS 150 one month back

Also complains of intermittent erythema and hyperpigmentation in lower limbs

On liquid paraffin

She works in subdivision hospital and needs to get her Hba1c done outside and can't trust the local labs. Last Hba1c was done one year back and she's trying to search her mobile phone to retrieve that! Says it was apparently in the normal range.

She's one patient who didn't buy into our PaJR system and we don't have a good case report/record of her ever since we first met her in 2014! 

Due to this informational discontinuity we couldn't even optimise her medications properly because she had a habit of suddenly popping up into our WhatsApp text and we would again have to retrieve her information from scratch with many holes as she wouldn't have been able to share them again in sequence and our own irritation with her not getting her data sequentially in one place!

10-12-2024

PPM 1 - GRBS

4.00pm -163

8.00pm - 144

10pm - 139

2.00am - 124

7.00am - 115

PA - The patient takes glimiperide 2mg one time before dinner.

Metformin 500mg two times after lunch and dinner.

PPM 1 - Alright. Continue to take that way.

 

PPM 1 - @PPM3 please update the blood sugar profile values

PA - Sir Kunal hasn't seen the orthopedic surgeon yet.

PPM 1 - @PPM3 please check if the Orthopedic people saw this patient's son today?

PPM 3 - Okay sir.

PPM 1 - Also please share the three discharges.

They are all three planned to be discharged in the morning tomorrow as they have a train to catch.

PPM 3 - Ok sir.

PPM 3 - GRBS

8.00am - 115

10 am  - 140

1 pm - 135

3 pm - 115

8pm - 122

10pm - 152

2 am - 103

8 am - 62

10am - 223

1 pm - 220

3 pm - 173

PPM 1 - 👍

12-12-2024

PPM 1 - Discharge done for all three?

What about the son's final orthopedic resolution?

PA - No sir.

PPM 1 - I'll try to request the Orthopedic Professor to visit your patient at 10 am as soon as our current 9 - 10 am meeting is over.

PA - Ok sir.

PPM 1 - GRBS

8 am - 62

10 am - 223

1 pm - 220

3 pm - 173

8 pm - 84

10 pm - 190

2 am - 250

8 am - 146.

The above sugar values are from 8 am on 11-12-2024 to 8 am on 12-12-2024.

PPM 3 - All discharges are ready sir, waiting for signatures sir.

PPM 1 - Share the de-identified summary here now for 52F and her son and I shall sign as soon as the clinical meeting is over.

PPM 3 - Ok sir.

PPM 1 - The diagnosis needed to have been changed. It's suspected right shoulder joint ligament tear.

PA - Now what should the patient do sir.

PPM 1 - Keep updating the patient's details here regularly at least once a week.

PPM 1 - The case reporter will inform you further.

PA - Ok sir.