Seemala Anjali 123

 This is an online e log book to discuss our patient health data shared after taking his/her/guardians singned informed consent. Here we discuss our individual patients problems with an aim to solve the patient’s clinical problem with collective current best evident based input. This E blog also reflects my patient cantered online learning portfolio and your valuable inputs on the comment box is welcome.I have been given this case to solve in an attempt to understand the topic of “patient clinical data analysis” to develop my competency in reading and comprehending clinical data including history, clinical findings,investigations and come up with diagnosis and treatment plan. Case: A 77 year old female presented to  Ophthalmology opd with complaints  of  diminishion of vision in right eye. History of present illness:  Patient was apparently asymptomatic 1 year back when she had nocturia due to which she went to the hospital and was diagnosed with diabetes for which she was medication.

Case : A 77 yr old female with uncontrolled diabetes mellitus  OSCE questions:  1)  Steroid induced diabetes mellitus Steroid-induced diabetes mellitus is defined as an abnormal increase in blood glucose associated with the use of glucocorticoids in a patient with or without a prior history of diabetes mellitus.  The criteria for diagnosing diabetes by the American Diabetes Association  is   8 h fasting blood glucose ≥ 7.0 mmol/L (126 mg/dL),  2 h post 75 g oral glucose tolerance test (OGTT) ≥ 11.1 mmol/L (200 mg/dL),  HbA1c ≥ 6.5% or in patients with symptoms of hyperglycemic, a random plasma glucose of ≥ 11.1 mmol/L (200 mg/dL) . The effect of glucocorticoids on glucose metabolism is likely the result of impairment of multiple pathways including beta cell dysfunction (sensitivity to glucose and ability to release insulin) and insulin resistance in other tissue. RISK FACTORS:  Proposed risk factors for steroid-induced diabetes beyond cumulative dose and longer duration of steroid cou