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Abstract: Type 2 diabetes mellitus is a chronic metabolic disease. The patient had the disease for 10 years and had not been treated regularly, and visited the clinic after developing blurred vision and numbness in the lower limbs, and physical examination revealed that fasting blood glucose was elevated to 9.3 mmol/L, glycosylated hemoglobin 7.1%, and postprandial blood glucose 9.8 mmol/L. After drug treatment, the patient’s blood glucose dropped, and numbness in the hands and feet and blurred vision disappeared, and the disease was under control. All indicators are improving.
Basic information】Male, 65 years old
Disease Type】Type 2 diabetes mellitus
Hospital】Beijing Hospital
Date of Consultation】May 2021
Treatment plan】Medication (metformin hydrochloride tablets, glycine insulin injection, acarbose tablets, resulvastatin calcium tablets, temisartan tablets, nifedipine extended-release tablets, haematocrit injection, lipoic acid injection, calcium hydroxybenzenesulfonate capsules)
[Treatment period] 14 days of hospitalization, 1 month of outpatient follow-up
Treatment effect】The disease has been controlled, and all indicators are improving
I. Initial consultation
Patient’s self-report: 10 years ago, he found dry mouth and itchy skin, and his fasting glucose rose to 9.3 mmol/L, glycosylated hemoglobin 7.1%, and postprandial glucose 9.8 mmol/L. He was diagnosed with type 2 diabetes. Initially, he was given oral treatment with metformin hydrochloride tablets and Repaglinide tablets, but the glycemic control was not very satisfactory. After 3 months of control, his fasting blood glucose was 7.1 mmol/L, postprandial blood glucose was 13.6 mmol/L, and glycosylated hemoglobin was 8.4%. The patient has been refusing to receive insulin therapy, since then intermittent medication, self-adjusted medication, no further follow-up. 3 years ago, gradually developed blurred vision, no special treatment. 1 year ago, developed numbness in both lower limbs, obvious on the left side, no fever, no nocturnal resting pain and other concomitant symptoms. On this visit, fasting glucose of 12.61 mmol/L and glycosylated hemoglobin of 10.3% (see figure below) were found in the outpatient clinic, and the patient was admitted to the hospital. The patient’s previous history of hyperlipidemia and hypertension was understood. Hypertension was currently treated with valsartan capsules and amlodipine benzoate tablets, and blood pressure was controlled at about 130/80 mmHg. On examination: BP was 160/90 mmHg, clear speech, respiratory clear sounds in both lungs, no dry and wet rales were heard, heart rate was 73 beats/min, rhythmical, no murmur in the auscultation area of each heart valve, abdominal softness, no pressure pain, rebound pain and myalgias, liver and spleen were not palpable, mild edema in both lower limbs, diminished fluctuations in the dorsalis pedis artery on the left side, normal fluctuations in the dorsalis pedis artery on the right side, double Barr’s sign (-). Preliminary diagnosis: 1, type 2 diabetes mellitus, diabetic peripheral neuropathy, diabetic retinopathy; 2, hypertension grade 2, very high risk; 3, hyperlipidemia.
II. Treatment history
After this admission, the patient was examined by an ophthalmology consultation and found that: a large number of bleeding points were found in the capillaries of the fundus (see the figure below), and laser surgery was considered for treatment. After repeated persuasion, the patient finally agreed to receive insulin therapy, so the treatment plan was set as metformin hydrochloride tablets combined with glargine insulin injection subcutaneously. to improve the circulation, lipoic acid injection to nourish the nerves, and ophthalmologic treatment with total retinal photocoagulation, followed by calcium hydroxybenzenesulfonate capsules to improve the microcirculation in the fundus.
(Ophthalmic examination)
III. Treatment effect
After receiving fundus laser treatment, the patient’s vision was restored in both eyes. 14 days after treatment, the patient’s numbness in both lower limbs disappeared, and the fasting blood glucose was controlled at 5-7 mmol/L and postprandial blood glucose was controlled at 8-9 mmol/L. One month after discharge, the outpatient follow-up showed that the fasting blood glucose was 6-7 mmol/L, postprandial blood glucose was 7-9 mmol/L, and glycation was 6.6%, so the blood glucose was well controlled. The above situation was fed back to the patient and family members, and everyone was very satisfied with the treatment effect.
IV. Notes
We are glad that the patient’s condition improved after treatment. After discharge, the patient was instructed to make sure to strictly control the diet, to achieve sugar-free, low salt, low fat, regular three meals a day, correct dyslipidemia and control hypertension. Half an hour after meals, 20-30 minutes of moderate intensity aerobic exercise, such as jogging, brisk walking, etc., is recommended every day. Monitor fasting blood glucose and blood glucose after three meals regularly every day. Patients should strictly follow the doctor’s prescriptions for medication and make regular hospital visits for review and adjustment of medication, and self-adjustment of medication at home is not recommended. Patients should regularly review the fundus condition and changes in the affected limbs, pay attention to whether there are changes in the skin temperature of the lower limbs, whether there is pain in the lower limbs after walking, etc., and strengthen foot care to prevent infection.
V. Personal insight
This is an “old glucose patient” who is very self-aware, with poor compliance, and often discounts the treatment plan formulated by the doctor, so the glycemic control has been poor, and long-term elevated blood glucose has caused more chronic complications. Only after the quality of life was seriously affected did the patient agree to receive insulin therapy. In the follow-up treatment, we should also closely monitor the degree of implementation, strengthen the communication with patients and their families, and urge patients to adjust the treatment plan with timely follow-up. After receiving insulin therapy, we should also be alert to the occurrence of hypoglycemia. Chronic diseases such as diabetes and hypertension often stay with patients for the rest of their lives. Doctors must strengthen patient education, urge patients to treat regularly, follow up regularly and adjust their treatment plans in a timely manner. Only in this way can we help reduce the occurrence of acute and chronic complications, effectively improve quality of life and extend life expectancy.