OSCE

How do you treat recurrrent non healing ulcers in Diabetes?

Recalcitrant non-healing ulcers are inevitable and detrimental to the lower limb and are a major cause of non-traumatic lower limb amputations. Application of autologous Platelet Rich Plasma (PRP) has been a major breakthrough for the treatment of non-healing and diabetic foot ulcers, as it is an easy and cost-effective method, and provides the necessary growth factors that enhance tissue healing. PRP is a conglomeration of thrombocytes, cytokines and various growth factors which are secreted by α-granules of platelets that augment the rate of natural healing process with decrease in time.

What might be the cause of vomitings in a patient of Diabetes?

Factors related to your diabetes may cause you to experience nausea.
Medication:
Metformin is one of the more common medications used to treat diabetes. Nausea is a potential side effect for people taking this medication. Taking metformin on an empty stomach may make nausea worse.Injectable medications used to treat diabetes, such as exenatide (Byetta), liraglutide (Victoza), pramlintide (Symlin), and other glucagon-like peptide-1 (GLP-1) agonists may cause nausea.

Artificial sweeteners and sugar alcohols:
In an attempt to manage blood sugars, many people with diabetes turn to artificial sweeteners and sugar alcohols to minimize their regular sugar intake.
However, a common side effect of added sweeteners, like xylitol is nausea, as well as other digestive symptoms. When someone has more than one serving per day,the side effects may be amplified.
Aspartame, a popular artificial sweetener, can cause nausea.

Types of MODY (Maturity onset diabetes of young)??
    MUTATIONS   and   PHENOTYPES HNF4alpha - adolescent or early adult in onset: progressive in insulin secretory defect.
GLUCOKINASE-Since birth:stable mild fasting hyperglycemia
HNF1alpha-adolescent or early adult in onset: progressive in insulin secretory defect.
IPF-1 - Early adult : mild Diabetes
HNF-1beta- Adolescent: progressive diabetes
Neuro D1- Early adult : rare
KLF11- Early adult : Pancreatic atrophy
CEL,PAX4,INS,BLK.

LEARNING POINTS:
I learnt the pathophysiology of Type 1 and Type 2 DM
I got to know how to diagnose between type 1 and Type 2 based on the treatment response shown by the patient
I also learnt about the phenotypic features of different mutations in MODY
I learnt about the various complications of Diabetes
This case helped me to know the cause of recurrent healing ulcer, its association with diabetes and its management
This case also helped me to know that it's important to evaluate side-effects of the drugs (overdosage) given and wrong medications taken by the patient which was prescribed by any RMPs.


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