A 33years Male Patient With Uncontrolled Diabetes.

THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT 
CHEIF COMPLAINTS:-
C/O blisters over both foot since 2years back. 
Pain in abdomen and constipation since 1year. 
Pain on either side of the jaw since 6 months. 
HISTORY OF PRESENT ILLNESS :-
Patient was asymptomatic 7 years back and then he developed pain in the abdomen and epigastric burning sensation, for which he visited to local hospital and was diagnosed to be having diabetes and followed by which he developed papules over the foot ,which lead to blisters and hyperpigmentation of skin,on the skin of tibia of both limbs 2 years ago, not associated with itching.  
Patient had pain while eating since 6 months on both sides of the jaw.  
H/O both parotid swelling. 
ON EXTRAORAL  EXAMINATION  
Patient was concious, coherent and co-operative .
No gross facial asymmetry seen.
TMJ examination reveals clicking sounds on both sides. 
Tenderness over the both TMJ region. 
No deviation of mandible on mouth opening and closing. 
Mouth opening is 30mm approximately. 
HISTORY OF PAST ILLNESS :-
K/C/O Diabetes since 7years. 
Patient developed itching over penis region 2 years back.
Patient has been diagnosed with balanoposthitis and under medication. 
TREATMENT HISTORY:-
Diabetes- yes 7years back 
PERSONAL HISTORY:-
Married
Occupation- fruits seller
Appetite-normal 
Diet- Non veg
Bowels- regular 
Micturition- normal 
Known allergies- no
FAMILY HISTORY:-
no significant family history 
GENERAL EXAMINATION:-
no pallor, cyanosis, icterus, lymphadenopathy, clubbing of fingers or toes, Oedema of feet, malnutrition, dehydration. 
VITALS:-
Temp- 98.6
Pr- 86/ min
Rr-18/ min
Bp-110/70 mm /Hg
Spo2- 98%
GRBS-126 mg%
SYSTEMIC EXAMINATION:-
a)CVS - S1 S2 Positive 
b)Respiratory system- normal 
c)Abdomen- soft, non tender
d)CNS
    Level of consciousness- alert
    Speech- normal 
     Signs of meningeal irritation like neck           
      Stiffness, kerning 's sign- no
     Cranial system, motor system, sensory 
     system- normal.
     no cerebral signs
INVESTIGATIONS:-
ECG
Right side of the face 
Left side of the face 
Front view of the face 
PROVISIONAL DIAGNOSIS:-
Uncontrolled DM-2 since 7years. 
Mild TMJ dislocation on right side. 
DIAGNOSIS:-
Uncontrolled Dm-2
TREATMENT:-
A) For Diabetes 
Tab.GLIMIPRIDE 2mg before food.
Tab.METFORMIN- 500mg TID after food. 
B) For TMJ DISLOCATION 
Conservative management has been explained to the patient. 
Avoid wide opening of mouth. 
Advised to have hot fomentation over the TMJ region. 
Tab.FLEXON MR - BD for 5days. 










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