25year old female with diabetes

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25 year old female student by occupation resident of westbengal came to opd with 

C/c of 

    Swelling in both limbs since 6 years 

   Headache on backside since 6 years 

Hopi:-

Patient was apparently asymptomatic 6 years ago.On one day after she wakes up in the morning  she noticed swelling in the both limbs below knee level mainly at the level of foot which is  insidious in onset progressive with  no aggravating factors and  relieved on massage and not associated with pain. The swelling is more when she was sleeping 

H/o headache since 6 years  in the occipital region and associated with photophobia and phonophobia and no history of lacrimation .

Headache is more when she gets up in the morning and relieved immediately after few hours on its own  for which she went to hospital and after examination she was diagnosed with migraine.

Later ,she went through few routine blood investigations and was diagnosed with Anemia . When she was found anemic , they adviced her to get Hb electrophoresis result shown that her Hb E levels are high .

History  of pain while writing since 7 years  which used to start after writing a paragraph (20-30 lines) relieved on rest. It is non radiating, intermittent in nature .

Past history:- 

----One year back ,around june- July She had severe tooth pain ,consulted a dentist  and there  she got to know about high blood sugar levels  and then she was treated her conservatively until blood sugars are normal and treated her accordingly.She used 

Lipoglobin HD bd 

Vildamne 50mg in the night 

-----In the month of August , She had pain in left upper quadrant, consulted a physician ,  she was diagnosed with gall stones on USG and  underwent laparoscopic cholecystectomy in December 2022.

------ No history of hypertension ,asthma ,tb

Personal History:- 

     Diet - Mixed 

    Sleep - Adequate 

    Appetite - normal 

    B&B - regular 

    No addictions .

Family history 

    History of diabetes for her grandfather 

Treatment history 

   Tab.VALDiMAC 50 

    Tab.FOLIC ACID 5 mg 

    

General examination:- 

    Patient is conscious, coherent, co operative well oriented to time place and person 

Pallor present +

No icterus,

Nocyanosis, 

No clubbing,

No lympadenopathy ,

No  edema 

Vitals:- 

Temp:- 98f 

Pr- 96bpm 

Rr- 16cpm 

Bp- 120/80mm hg 

Spo2- 96% 

Fasting blood sugar -191 mg/dl

Post prandial blood sugar -241mg/dl

Systemic examination:- 

    Cvs- S1S2 heard , no murmurs 

    Rs- BAE present , NVBS present 

    P/A - soft , non tender 

   CNS- No neurological deficits 

Provision diagnosis:-

     Diabetes and anemia under evaluation

Investigations 

 2022 

USG 

Present 

Hb - 6mg/dl

Complete blood picture