Increasing age - Body is less weak to fight disease

History of diabetes - higher risk of diabetes coming back

Borderline BMI - 25

Lifestyle habits - smoking too much (20 sticks😱) and drinking beer

Security guard - sedentary lifestyle

• 1 pack per day for past 25 years, 25 pack-years

• Enjoys drinking beer

• Fatigue, frequent headache

• Blurry vision

• Frequent urination

Mr Tan's objective data:

• 65 years old

• Left toe wound infection

• HTN + HLD 3 years, T2DM 10 years

• BMI 25

• Medication of

  • Enalapril (HTN) 2.5mg OM

  • Lovastatin (HLD) 20mg ON

  • Oral Metformin (T2DM) 500mg BD

• Fasting plasma glucose

• Postprandial plasma glucose

• Random glucose (glucometer reading)

• HbA1C = high proportion of glycosylated Haemoglobin, showing that his blood glucose is high over past 2-3 months

Therefore, indicates hyperglycaemia due to his poor management of DM II

Poor management in areas such as:

• Diet - high sugar & fat

• Exercise

• Smokes

• Weekly consumption of beer

• BMI = 25 (high)

Polyuria: glucose in the urine draws in water via osmosis

Polyphagia: cells in body are unable to take in glucose due to the absence of insulin/ the cells are resistant to insulin, so the body signals to the brain to eat more food, resulting in even higher glucose levels

Glucosuria: the high blood glucose levels in the blood exceeds the kidney cells ability to reabsorb glucose

Blurry vision: associated with microvascular complications of diabetes

Weakness, fatigue: due to depletion of proteins

High plasma blood glucose levels: due to lack of insulin/insulin resistance

HIGH Postprandial plasma glucose (23mmol/L) normal range is <11.1

HIGH Random Glucose (18mmol/L) normal range is <11.1

HIGH HbA1C (12%) normal range is <7

Other investigations that can be done:

Arterial Blood Gas test, Diabetic Retinol Photography, Diabetic Foot Screening, Wound Culture

Peripheral arterial disease (PAD) due to atherosclerosis and microvascular damage results in reduced oxygen and nutrient delivery to the wound site.

Delayed re-epithelialisation and weak granulation tissue formation lead to prolonged wound healing.

Hyperglycemia inhibits leukocyte function, particularly neutrophils and macrophages, reducing the body’s ability to fight infection. Reduced chemotaxis and phagocytosis impair the clearance of bacteria and debris from the wound.

Blurry vision is due to micro vascular damage which can lead to diabetic retinopathy and can cause blindness

Sensations in hands and right foot is positive, with reduced ability to feel pain on left foot suggest diabetic neuropathy

Wound is due to combination of microvascular damage and neuropathy, linked to diabetes

High temperature of 38.2 degrees and slightly high heart rate if 102 beats per min is possibly due to infection of the wound

Elevated BP of 127/75 mmHg is due to hypertension