Patient 10, A 48 year-old female was admitted to BCDH with an ulcer on her right leg, she has 17 years history of diabetes and 6 years history of numbness of the soles of her feet. Before she was admitted, she had been advised to have an amputation.
Physical exam revealed a temperature 39.3 ¡æ , BP 130 / 80 mmHg, pulse rate 98 / min. On the front of right lower leg there was an erythematous ulcer 13 ¡Á 8cm, with two abscesses in the centre with exudation. Both feet were claw-shaped, dry, pulseless and cold.
Lab tests revealed WBC 13.8 ¡Á 10 9/ L, polys 91.1%, urine ketone +++, urine protein ++, fasting blood glucose 16.9mmol / L, HbA1c 11.3%, X-ray revealed no osteomyelitis in the leg and Doppler revealed arteriosclerosis in both lower limbs. An eye exam revealed retinopathy grade IV. An oral glucose tolerance test showed low insulin levels after glucose administration . |
The patient suffered from type 2 diabetes, diabetes ketosis, gangrene grade §º of right lower limb and retinopathy grade IV. After one month comprehensive therapy her temperature was normal, ketone was negative, urine protein was negative, fasting blood glucose levels were around 6-7mmol / L, and her gangrene healed. |
