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High WBC and high neutrophils-> Right foot wound infection
Low Hb-> Diabetic foot ulcer is slow to heal
High Fasting  plasma glucose, Postprandial plasma glucose, Random Glucose (glucometer reading),
HbA1C>  Uncontrolled Type 2 DM
Borderline high LDL-> Hyperlipidemia

Additional lab:
Urea ketones, ABG, diabetic neuropathy exam, monofilament test

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Type 2 DM l, poor controlled which lead to high sugar level. Leading polyuria.
High glucose reading which might result in conjunctivitis micovascular complication
Micro vascular complication leading to slow wound heading

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Patient DM has lead to neuropathy which is the loss of sensation due to damaged nerves caused by the uncontrolled DM. Hence, the patient cannot sense the pain and it became infected.
Neuropathy also means the functions of cells involved in wound healing is impaired - neutrophils, macrophages, fibroblasts.

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What are the current treatment approaches for T2DM?

Monitor blood glucose (before meals: 4-7mmol, after meals: <8.5mmol)

Lifestyle modification: BMI (normal range, exercise, diet, go for smoking cessation programme, reduce drinking alcohol)

To take prescribed medication:

1. Insulin Mixtard (Patient education on how to administer (subQ inj), signs of hypoglycaemia/hyperglycaemia)

2. Oral medication: Metformin (Biguanide) - reduces blood glucose

DASH diet (focuses on vegetables, fruits and whole grains, low sugar diet)

Wound screening at the polyclinic regularly

Annual foot screening, annual eye screening for diabetic patients

Ensure proper foot hygiene to prevent worsening of the ulcer, and frequently moisturize the dry legs

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Normal
BP - normal
SpO2 - normal
White sclera, pink palpebral conjunctiva - normal
Heart - normal
Peripheral capillary refill - normal
Abdomen - normal

Abnormal
Temperature - high, fever ( right toe infection)
HR - high (right toe infection)
RR - high (right toe infection)
Appearance- fatigue (Decreased energy catabolism)
Pulses - weak right foot pulse (Peripheral Arterial Disease)
CNS - reduced ability to feel pain in right foot ( due to diabetes) (neuropathy)

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C2:
Uncontrolled DM Type 2.
BMI 25 and enjoy drinking beer at least once a week

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D2: Other complications of DM
1) Macrovascular complications due to damage to the larger blood vessels: resulting in peripheral vascular disease, myocardial infarction, and stroke.

2) Microvascular complications due to damage to the tiny blood vessels throughout the body: In the kidneys, microvascular damage ultimately leads to diabetic nephropathy, which causes renal insufficiency and failure. In the eyes, microvascular damage can lead to diabetic retinopathy and can eventually cause blindness.

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A1:

Objective:

Temperature: 38.2oC

BP 127/85mmHg

HR: 102 bpm

RR: 21 bpm

Appearance: Fatigue

White sclera, pink palpebral conjunctiva

Heart: S1, S2 sound- normal, (-) regurgitation or (-) murmur

Peripheral capillary refill: +ve 3 sec

Abdomen: (-) Epigastric tenderness

Pulses:

weak foot pulse on right Dorsalis Pedis

(+) foot pulse on left Dorsalis Pedis

Subjective:

frequent urination

fatigue

blurry vision

frequent headache

right toe wound infection

A2:

Modifiable Risk Factors
- Overweight (BMI of 25)
- Lifestyle Factors- smokes 20 sticks of cigarettes/day, drinks beer at least once a week

Non-Modifiable Risk factors
- Age (65 years old)
- Gender (Male)
- Past medical history of Hypertension and hyperlipidaemia for 3 years