SWIFT
ADEPT AID

Prompt expert action helped a 30-year-old
male diabetic patient with a foot injury

A 30-year-old male, a resident of a small village in Kerala, working as a craftsman in a workshop in Mumbai, was admitted to Nanavati Super Speciality Hospital 's general ward after sustaining a foot injury at the workshop. The patient was diagnosed with Diabetes Mellitus (DM) 5 years back when his blood glucose levels were found to be high during a routine check-up. After the diagnosis, the patient was started on Oral Hypoglycemic Agents (OHA’s).

Given his foot injury, urgent surgery was needed. He was rushed to the hospital, and at the time of admission, his blood sugars were recorded to be >400 mg/ dl, but urine and serum ketones were absent. As surgical intervention was urgently needed, insulin by intravenous (IV) drip was started before the operation to stabilise the blood glucose. Postoperation, he was put on insulin subcutaneous (S/C).

1

The patient was discharged after the surgery and was told to get the dressing done daily and to take insulin regularly to stabilise his blood glucose levels. The patient came for follow up in the Diabetic OPD, and his blood glucose levels were found to be well-controlled thanks to his insulin intake. He was advised to continue with his insulin and regular follow-ups. However, the patient discontinued taking insulin after the wound healed and switched to old oral medications on his own accord.

Investigation of family records of the patient revealed a history of diabetes in paternal uncles, who were also diagnosed with Diabetes Mellitus in their early 20’s just like the patient. His parent’s

history was also unknown. He had the typical history of abdominal pain since early childhood, which was treated by painkillers, and fatty stools after heavy meals. No traits of smoking or alcohol consumption were recorded.

The patient's vitals and other parameters after changing to OHA’s were recorded as follows: Body Mass Index - 19, Blood Pressure - 110/70 mmHg, Fasting Blood Sugar - 250, Post Prandial Blood Sugar - 335 and no urinary ketones as before. In view of his history and investigative findings, the patient was advised for X-ray abdomen erect, USG / CT Abdomen C-peptide, GAD Antibodies, Serum Glucagon levels, Amylase / Lipase. The X-ray result showed calcification in the pancreas; his C-peptide was low which explained the lack of insulin in the body and low glucagon levels, which is why the patient never went into ketoacidosis despite high blood sugar levels and low insulin in the body.

Fibro Calculous Pancreatic Diabetes (FCPD) is a unique form of diabetes secondary to Chronic Pancreatitis seen in developing countries of the world associated with either over protein-calorie malnutrition or more likely, with deficiency of certain micronutrients. Its occurrence is reported to be more in South India, with most cases diagnosed among the young and adolescent age groups. Some of its symptoms include low BMI, abdominal pain, steatorrhea, no ketosis, among which pancreatic calculi is the hallmark. In most cases, they respond very well to insulin. There is also a risk of developing Pancreatic Cancer in some patients.

 

dr-mihir

Dr. Mihir Raut
Consultant
Physician & Diabetologist
Nanavati Super
Speciality Hospital
Mumbai

1