Case study adult type 2 dm with obesity

1. Case managed as adult obese newly diagnosed type 2 DM
had impact socio-economic ???
The highly positive effect with
1-weight reduction encouragement regimen
2- positive role of psychological support

2. OMAR : Obese 20 ys, old male Saudi.
No past history.
his weight 103 kg height 181 cm
BMI = 33
B/P 130/70
F.H.: DM/HTN/IHD/DYSLIPIDEMIA
Came to endocrine/diabetes clinic at July 2015 ;
Cash patient /financial barrier
with classical symptoms of diabetes
• Polyuria
• Tiredness
• Weight loss
• Thirst sensation
• Blurring of vision
Dr./ Adel El-Naggar
Endocrinologist

3. His lab work at 1st visit in July 2015:Dr./ Adel El-Naggar Endocrinologist

4. Dr./ Adel El-Naggar Endocrinologist

5. Pancreatic function tests
Blood gases/PH
Dr./ Adel El-Naggar Endocrinologist

6. OMAR
………..was obese 103kg BMI=33
OMAR
………….had finical barrier
OMAR
………had multiple risk factors DM/obesity
OMAR
………had +ve F.H.
OMAR
………..was symptomatic
Dr./ Adel El-Naggar Endocrinologist

7. Plan of management for Omar
As regard his risks & symptoms:
1-Life style modifications
*Exercise
*Physcological support for
weight loss encourage as first line to
manage his diabetes
2-Basal insulin levemir
20 iu od p.m. s.c for first one month
to resume his anabolism and stop his
symptoms
plus
3-Janumet 50/1000 mg tab bid
Dr./ Adel El-Naggar Endocrinologist

8. After one week of this regimen
/less symptoms/ CBS controlled
After more than one month of this regimen
CBS controlled ; stop levemir insulin
Continue only on janumet 50/1000 mg bid
Dr./ Adel El-Naggar Endocrinologist

9. After 3 months from baseline HbA1c & management plan
OMAR was only on janumet for more than 7 weeks
Dr./ Adel El-Naggar Endocrinologist

10. OMAR after 4 months later on
Janumet 50/1000 mg bid
Plus
Life style modification
Exercise
Physicological support
Dr./ Adel El-Naggar Endocrinologist

11. Now OMAR on February 2016;
LAST CLINICAL DATA:
HbA1c was 5.7% vs 9.2%
His weight now 95 kg vs 103 kg
BMI=29.8 vs 33
NO SYMPTOMS
Physicologically motivated
for his weight reduction
& his DM control
Dr./ Adel El-Naggar Endocrinologist

12. OMAR now on
• Janumet 50/850 mg bid
(Dose reduced)
His CBS excellent controlled:
His FBS not exceeds 110 mg/dl
His PPBS not exceeds 140 mg/dl
Plus
• Life style modification
• Exercise
• Physicological support
Dr./ Adel El-Naggar Endocrinologist

13. THANK YOU
DR./ ADEL EL NAGGAR
Dr./ Adel El-Naggar Endocrinologist