CASE REPORT

DIABETES MELLITUS

ARRANGED BY:

Name : Eza Melinda

NIM : 2012730034
PRECEPTOR: dr. Hj. Ihsanil Husnah, Sp.PD

Department of Internist
Islamic Hospital of Jakarta, Cempaka Putih
Medical Faculty of Muhammadiyah Jakarta University
Period July 3th 2017-July 30th 2017
 SUBJECTIVE (S)

Patient’s Identity
• Name : Mr. S
• Age : 39th years old
• Address : St. Rusun Jati Rawasari Cempaka Putih
• Religion : Moslem
• Occupation : Private employees
• Marital status : Married
• Education : Senior High School
• Date of admission : July,7th 2017
• MR. Number : 00970907
 SUBJECTIVE (S)

Chief Complaint
Tingling in both legs since 1 week before entering the hospital.

Additional Complaints
The patient feels dizzy and both of his feet felt pain.
History of Present Illness

Patient came to Polyclinic`s Islamic Hospital of Jakarta,

Cempaka Putih with a continuous tingling sensation in both of his
legs. Initially his legs hurt and gradually became tingling. Patient said
that in the night, frequent urination and often felt thirsty. His weight
loss till 5 kg, but he had a good appetite and ate a lot. Patient also
complained his body is often weak and his head felt dizzy.
Now the patient is in the second month for tuberculosis
treatment. Patient did not complain of cough during lung treatment,
but sometimes he still often sweat out at night.
The patient did not know that he had diabetes mellitus
before, and this is the first time he went to the internist. He had just
know if his glucose test is high after being checked at the Primary
care and getting referrals from the pulmonary poly clinic when he was
being treated.
 SUBJECTIVE (S)

History of Past Illness

• No history of same problem before
• No history of Hypertension
• No history of urinary or kidney disease
• No history of cardiovascular disease
 SUBJECTIVE (S)

History of Family
• None of his family has same problem
• His mother had history of hypertension
• No history of diabetes mellitus
• No history of cardiovascular disease
• No history of respiratory disease
History of Allergy
• Patient has no allergy of food, drugs and weather.

History of Treatment
• Patient have not taken any medications to reduce his
glucose, but patients only drink some rifampicin,
isoniazid, pyrazinamide and ethambutol drugs for the
treatment of tuberculosis

History of Psychosocial
• Patient said that he often ate sweet foods and more than
3 times a day. Patient smoked but did not drink alcohol.
 OBJECTIVE (O)
PHYSICAL EXAMINATION
 General Status : Mild ill
 Consciousness : Composmentis
 Vital Sign
BP : 120/80 mmHg RR : 18x/mnt
HR : 76x/mnt Suhu : 36,9 ◦ C
 Anthropometric Status
Body Weight: 50 kg
Body High: 163 cm
BMI : 18,83 kg/m2
GENERAL PHYSICAL EXAMINATION
 Head : Normocephal, deformity (-)

 Eyes : Anemic conjungtiva (-/-), icteric sclera (-/-)

 Nose : Epistaksis (-/-), deviasi septum (-/-)

 Mouth : The oral mucosa moist

 Neck : Mass (-), lymphadenopathy (-)

 Thoraks :
Inspection : the movement of the chest symmetrical
Palpation : vocal fremitus is same in dextra and sinistra
Percussion : Sonor
Auscultacion : vesicular breath sounds + / +, ronkhi - / -, wheezing - / -
GENERAL PHYSICAL EXAMINATION

 Heart :
Inspection : ictus cordis not seen
Palpation : ictus cordis not palpable
Percussion : Right heart margin: sternalis line sinistra ICS-V
left heart margin: midclavicula line sinistra ICS-V.
Auscultation : Regular 1st & 2nd heart sounds, murmur (-), gallop (-)

 Abdomen :
Inspection : looked flat
Auscultation : bowel (+) sounds, 7x/minutes
Palpation : pressure pain (-), ascites (-)
Percussion : timpani, shifting dullness (-)
GENERAL PHYSICAL EXAMINATION
 Extremities:
Superior : Edema (- / -), warm akral(+ / +), RCT <2 seconds (+ / +)
Inferior : Edema (-/ -), warm akral (+ / +), RCT <2 seconds (+ / +)
 LABORATORY EXAMINATION
Date 05/07/2017
 Resume
Mr. S, 39th years old, came with complaints of continuous
tingling in both legs. In the night frequent urination and often feel
thirsty. He was losing weight, but he had a good appetite and ate a
lot. His body felt weak and his head felt dizzy. Patient was currently
in the second month of tuberculosis treatment. The patient did not
know that he had diabetes mellitus before, and he had just know
that his glucose test is high. Patient liked to eating the sweet foods.
Physical examination : BP: 120/60 mmHg, HR: 76x/minute,
RR: 18x/minute, Temp : 36.9° C.
Laboratory examination: Plasma glucose : 610 mg/dL, BTA:
Positive (+).
 PROBLEM LIST

• Diabetes mellitus
• Tuberculosis
 ASSESMENT (A)
Diabetes Mellitus
S : Tingling in both legs continuously. In the night
frequent urination and often feel thirsty. Weight loss, but
he has a good appetite and ate a lot. The body feels gold
and head feels dizzy.
O : BP: 120/80 mmHg, HR: 76x/minute, RR: 18x/minute,
Temp : 36.9° C.
Plasma glucose: 610 mg/dL
A : Diabetes mellitus
P : Turning his lifestyles
Check and control the glucose
Humalog mix quick pen 12 IU/ml 2 x 1 ac
 ASSESMENT (A)
Tuberculosis
S : Cough for more than 2 weeks, sweating in the
night, weight loss, and body felt weak.
O : BP: 120/80 mmHg, HR: 76x/minute, RR:
18x/minute, Temp : 36.9° C.
BTA : Positif (+)
A : Tuberculosis
P : Rifampicin 450 mg 1x1
Isoniazid 300 mg 1x1
Pyrazinamid 500 mg 1x2
Etambutol 500 mg 1x2
 PROGNOSIS
Quo ad vitam : dubia ad bonam
Quo ad functionam : dubia ad bonam
Quo ad sanationam : malam
 LITERATURE REVIEW

DIABETES MELLITUS
 DEFINITION

Diabetes is a group of metabolic diseases was

characterized by hyperglycemia resulting from defects in
insulin secretion, insulin action, or both.
 EPIDEMIOLOGY
Globally, an estimated 422 million adults are
living with diabetes mellitus according to the latest
2016 data from the World Health Organization
(WHO). Diabetes prevalence is increasing rapidly.
Increases in the overall prevalence rates largely
reflect an increase in risk factors for diabetes type 2,
notably greater longevity and being overweight or
obese.
 ETIOLOGY
Table 1. The etiological classification of DM
Destruction of beta cells, generally leading to absolute
Type 1
insulin deficiency
• Autoimmune
• Idiopathic
Varies, ranging from the dominant insulin resistance with
Type 2
relative insulin deficiency to the dominant insulin secretion
defect with insulin resistance.
 Genetic defect of beta cell function
Another type
 Genetic defect of insulin work
 Pancreatic exocrine disease
 Endocrineopathy
 Because of drugs or chemicals
 Infection
 For rare immunology
 Other genetic syndromes associated with DM

Diabetes mellitus gestational

 DIAGNOSIS

Diagnosis of DM is established on the basis of

examination of blood glucose content. Blood glucose
examination is recommended is the enzymatic glucose
examination with venous blood plasma material.
 DIAGNOSIS
Various complaints can be found in people with DM. Suspicion
of DM need to be considered if there are complaints such as:
• The classic DM complaints: polyuria, polydipsia, polifagia
and unexplained weight loss.
• Other complaints: weakness, tingling, itching, blurred eyes,
and erectile dysfunction in men, as well as vulvar pruritus in
women.
 DIAGNOSIS
Table 2. Criteria Diagnose DM
 DIAGNOSIS
Table 3. Blood lab test for the diagnosis of diabetes and
prediabetes.
 DIAGNOSIS
Table 4. Fasting plasma glucose and plasma glucose content as
a filter and diagnostic DM (mg/dl)
 TREATMENT
• The purpose of management in general is to improve the quality of life of
people with diabetes. The goals of management include:

1. Short-term outcomes: eliminate DM complaints, improve quality of life,

and reduce the risk of acute complications.
2. Long-term outcomes: prevent and inhibit the progression of
microangiopathy and macroangiopathy complications.
3. The ultimate goal of management is the decrease in morbidity and
mortality of DM.

In order to achieve this goal,control of blood glucose, blood pressure, weight,

and lipid profile are required, through comprehensive patient management.
 TREATMENT
Tabel 5.
Recommended
anti-
hyperglycemic
therapy based
on ADA 2015
 REFERENCE
• American Diabetes Association. 2010. Diagnosis and Classification of Diabetes Mellitus. URL:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797383/pdf/zdcS62.pdf , Accessed 9 July
2017.
• Khardori, Romesh. 2017. Type 2 Diabetes Mellitus. Accessed 9 July 2017. URL:
http://emedicine.medscape.com/article/117853-overview#a4
• PERKENI. Konsensus Pengelolaan dan pencegahan diabetes melitus tipe 2 di Indonesia. 2015.
Pengurus Besar Perkumpulan Endokrinologi Indonesia. Jakarta. 2015
• Purnamasari, Dyah. 2014. Diagnosis dan Klasifikasi Diabetes Melitus. Buku Ajar Ilmu Penyakit
Dalam. Jilid II. Edisi VI. Jakarta: Interna Publishing.
• Soegondo, Sidartawan. 2014. Farmakoterapi pada Pengendalian Glikemia Diabetes Melitus
Tipe 2. Buku Ajar Ilmu Penyakit Dalam. Jilid II. Edisi VI. Jakarta: Interna Publishing.
• Suyono, Slamet. 2014. Diabetes Melitus di Indonesia. Buku Ajar Ilmu Penyakit Dalam. Jilid II.
Edisi VI. Jakarta: Interna Publishing.
• Tjokroprawiro, Askandar & Murtiwi, Sri. 2014. Terapi Nonfarmakologi pada Diabetes Melitus.
Buku Ajar Ilmu Penyakit Dalam. Jilid II. Edisi VI. Jakarta: Interna Publishing.
• World Health Organization, Global Report on Diabetes. Geneva, 2016. Accessed 8 July 2017.
TERIMA KASIH