A 37F suffering from Uncontrolled Diabetes Mellitus-2 from 2nd Pregnancy

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A 37 year old female patient complains of having uncontrolled Diabetes Mellitus type-2 from second pregnancy onwards. 

History of Presenting Illness:-

- For the past 10 days, the patient complains of Vaginal Infection (reoccuring the third time) 

- Fasting glucose levels= 300 and HbA1c reading = 12 for the past one year (i.e. since 2021 to 2022) 

- Upper Right Premolar broke

- Pain radiates from the right side above her tooth to the head and the right side of the face

- Lethargic

- Abdominal Pain (patient complains of the feeling of tightness and bloating) 

- Weak gums

- Increased frequency of urination (polyuria) 

History of Past Illnesses:-

On 2001,

Patient starts eating raw rice, even chews a few grains of rice during her sleep due to stress. 

This habit is persisting until now. 

On 2009,

- Weight was 63 kg 

- Left side wisdom tooth was extracted

- Dry, Flacky skin on vulva (This problem is periodic) 

On March 2010,

Root canal of all 4 molars were done. 

On June 2010,

She gets married. 

On July 2010,

   1st Pregnancy:-

        - Hb = 6

        - suffered from Iron deficiency (took iron tablets upon prescription) 

        - suffering from Calcium deficiency (still persisting) (tooth weakness and loose gum) 

         - Had sleep issues (some times she can sleep well and some days she stays awake) 

         - Lethargic

         - Vomitting (Morning sickness) 

On 6th November 2010,

While travelling on bike, almost collided with RTC bus at a turn. Patient felt a Jerk and a building up of excess pressure in her abdomen. When taken to the hospital, it was found that the fetus was still alive but there was excessive bleeding from the placenta. 

Foetus was aborted at 6 months. 

On September 2011,

2nd Pregnancy:-

        - Patient did not eat properly due to stress

        - Normal sleep cycle

On July 2012,

- Patient tried to undergo normal delivery but due to 16hr pain, she was adviced to go with C-section. 

- Delivery was successful, baby is a girl, weight of the baby= 2.9 kg

On May 2014,

3rd Pregnancy:-

        - Patient ate alot of raw rice very frequently. 

        - Abdomen felt bloated and tight. 

        - Concerned about fetal movement. She got her DOPLER done but it was normal. 

On Dec 2014,

     - Foetus was aborted due to high blood pressure of the mother. (Aborted foetus at 8th month) 

     - Physician adviced not to concieve for 3 years. 

On Feb to July 2017,

- Patient complains of big clot discharge and several abdominal pain for 6 months. 

- After conducting tests, Physician concludes that she has approached a pre-menopause. Therefore she is adviced not to concieve and adopt a child instead. 

On Aug 2017,

4th Pregnancy:-

        - Patient lost 3-4 kg weight in the beginning of the pregnancy, but that was regained towards the end of the pregnancy. 

        -Suffered from Vertigo for 2 days before diagnosos of Gestatipnal Diabetes.

         - For 3 and a half months, Cutanox, a blood thinner injection, has been given intramuscularly on the thigh (on a daily basis, which is approximately 100 injections). This was to increase blood flow to the placenta and dissolve any blood clots. 

        - In 7th month of Pregnancy, it was found out that she has Gestational Diabetes. 

       - After diagnosis of Gestational Diabetes Mellitus, her neck has a rash with bubbly appearance that itches alot and spreads. This is periodic and it stopped whenever she doesn't eat raw rice. 

        - During her pregnancy, she was also taking Insulin (Dose:- 6 units-7 units- 6 units, 3 times a day) 

        - 20-30 Masses (heat boils) on her buttocks, which went away after not eating raw rice for 20 days. 

        - Big and black mass next to her umbilicus. Physician says that it is a heat boil so the patient ignored and the boil went away. 

On May 2018,

     - Delivery was successful. 

     - Baby is a girl. 

     - She went to the nutritionist as sugar levels decreased after delivery. 

      - Therefore, she stopped taking insulin after pregnancy. 

On Feb 2019,

- Fasting Glucose crossed 100

- There is an increased intake of milk by the patient. 

- The patient starts to suffer from Vaginal Infection:-

    * Severe itching thought the day, especially increases in the evening. 

    * White discharge 

- Physician prescribed tablets for the couple but the patient's spouse wasn't compliant in taking the tablets. 

-Patient weight was 51 to 52kg.

-HbA1c=14, which after dieting it has decreased to HbA1c=6.1

On 2020, (DURING COVID OUTBREAK) 

- Patient was in Nalgonda for 1 year

- Weight was 56kg (has increased), due to:-

   * Increased stress levels. 

   * Increased frequency of raw rice intake. 

   * Increased intake of sugary tea per day. 

- Second bout of Vaginal infection, which was recovered after patient took the same tablets as the physician prescribed earlier. Spouce was again, not compliant. 

- For two years, while the patient was sleeping, she has been experiencing involuntary body jerks. 

On 2021,

-Weight of patient reduced to 50kg

-Within four months, it has further reduced to 45kg.

-Patient has moved to Hyderabad due to work reasons, currently working from home. 

-Creatine= 1.1, But after following a healthy diet, on a recent check up 1.5 to 2 months back, her creatine levels has reduced to 0.5.

On April 2022,

- Iron levels in the blood is 14.

- Patient takes Glucryl-M1 500mg (morning 1 tablet, evening 1 tablet; both before meal) and Insulin injections (10 units at bedtime) 

On July 2022

- Patient stops taking Insulin. 

-Bottom right and left molar has been split in half (the teeth on which the root canal procedure has been performed). 

Personal History:-

- Diet:- Follows a non-veg diet. 

         * Recently there is an increased intake of non-veg items. 

         * Increase in frequency in the intake of raw rice per day

         * Has sugary tea six times a day. 

- Appetite:- Normal

- Sleep:- Normal

- Polyuria

- Bowel movements:- Normal

- Menstrual Cycle:- Normal

         * Cycle = 3-4 days

         * No severe pain or cramps

         * No excessive bleeding

- Allergy:- Skin allergy (itchy bubbles on her neck, periodic in appearance, appearance after diagnosis of Gestational diabetes i.e. during her fourth pregnancy) 

- Weight fluctuations:- 

       * At 2009:- 63kg

       *During 4th pregnancy (Aug 2017 to May 2018) :- Lost 3-4 kg in the beginning but regained the same amount at the end of the pregnancy

        * Feb 2019:- (during first vaginal infection) :- 51-52kg

        * During 2020 (COVID pandemic) :- 56 kg (gained weight) 

         * At 2021:- weight reduced to 50kg and again after four months to 45 kg (recent weight) 

Drug History:-

- Took iron tablets on July 2010 (during first pregnancy) 

- For 3 and a half months (During fourth pregnancy), Cutanox, a blood thinner injection, has been given intramuscularly on the thigh (on a daily basis, which is approximately 100 injections). This was to increase blood flow to the placenta and dissolve any blood clots. 

- During her fourth pregnancy, she was also taking Insulin (Dose:- 6 units-7 units- 6 units, 3 times a day). 

- At the occurance of her first vaginal infection (Feb 2019) , including her second recurrent vaginal infection (2020), she was prescribed tablets. 

- On April 2022, Patient takes Glucryl-M1 500mg (morning 1 tablet, evening 1 tablet; both before meal) and Insulin injections (10 units at bedtime) 

-On July 2022:- Patient stops taking Insulin. 

Psychosocial Factors for increased stress:-

- Financial:-

       * Property issues

       * The patient's spouce doesn't have a job (has rejected two job offers in the past) and discourages patient to work. (Made her quit multiple jobs) 

       * Due to the patient spouce's AUD, he spent around 2 lakhs in the span of 6 months on alcohol

- Social:-

      * Patient is discouraged in communicating with relatives and have a social life. 

      * Has no support system and feels lonely. (Recently this support system from both her family side and her in-Laws side is improving) 

- Family:-

      *Patient's spouce and mother-in-law verbally abusing the patient (patient reports having extreme anger issues and an increased urge of eating raw rice whenever this happens) 

       *Patient faces psychological trauma

       *Patient spouce degrades their children and sometimes physically abuses them. 

       *Patient's spouce is reported to be agressive while driving and often resorts to death threats to the patient. Also has intentions to harm others. 

      *Patient's spouce has an AUD (Alcohol Use Disorder) and is often absent from home. 

- Job (Work life):- Patient also faces work pressures at her work place.