36 year old male with uncontrolled sugar,left lower rib fracture , ulcer in left toe

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A 36 year old male was admitted i/v/o left lower rib pain , uncontrolled sugar , Ulcer in left  toe 

History of presenting illness 

Patient was apparently asymptomatic 7 years ago .when he had an episode of giddiness and fallen he went to an hospital . Where he was diagnosed with diabetes mellitus .He started with OHAs he used to get his regular checkup done and FBS and PLBS were under control with metformin. He later shifted to GLIMI M1 and GLIMI MV2 2-3 months back . 

3 years ago patient started consuming alcohol and Didnt consume any food and developed pain in abdomen and was diagnosed with acute pancreatitis .He received treatment in an outside hospital .

3 years ago patient had a callus formation on left toe. Patient himself  used to cut it with blade which one year ago turned into an ulcer . He Underwent debridement for it a year ago. 

8 days back he fell from his bike and since then he is experiencing pain in his left lower rib area. Tenderness present .

Later he stopped taking OHAs for a 3daysand his sugar levels were uncontrolled . He was given insulin and his sugar was controlled. He later was discharged and sent to deaddiction center but as his sugars are still  uncontrolled with GLIMI M2 BD  he was sent to control his sugar levels .

History of past illness 

DM - 7 years

h/o chronic pancreatitis episodes since 3 years.

Vitals

Bp - 110/80 mmHg

PR -  106bpm

Cvs -  s1s2 +

Rs -  BA + 

                            USG abdomen 

                   

                     Xray ribs

Treatment 

18-3-2022

Tab.ultracet 1/2 u.d

Tab.Glimi M2 po/ oD

Tab.Glimi M3 po/oD

T. Dolo 650mg PO/OD

T.Thiamine PO/OD

T.lorazepam 2mg

T.Benxl PO/OD

T.Bacfen xl 20mg 

Inj.Tramadol

GRBS Charting

5am- 332mgdl

10am- 259mgdl 

7pm - 231mgdl

3pm - 245mgdl

19-3-2022

Tab.ultracet 1/2 u.d

Inj.HAI 6 units ---- 8 ---- 6 units 

Inj.NPH 5units---- x ---- 5 units 

T.Thiamine PO/ BD 

T.Lorazepam 2mg

T.Ben-xl PO

T.Bacfen- xl PO H/s 

Diagnosis 

Type II Diabetes mellitus uncontrolled