Transcription - 20251105T 16-25.mp3

But even I'm it's just on my temperature it my sugar mhmm is alright it's alright now yeah you're on the treatment the aed which probably just started yeah what do think triggered this dk off I I don't know I I had some long lasting insulin mhmm and I went to get some on monday I'd already did it a week before and it wasn't regular mhmm so I've had that over the weekend and I've been trying to just give myself normal insulin instead of the so you haven't had your long acting weekend no that'll be why then yeah yeah I know and what happened how did it run out well I had a week and I've said to her I've I've ordered over a week ago so I developed them they said yeah you did but you did nothing and what insulin do you take I take is it lantus it's in in I don't if it's in no it humulini or it's fizz and that's a quick acting 1 fizz fizz yeah and the other 1 how many units jio how many units are do you you doing take I think it's lantus I think takes 60 units of lantus at night then then how much does 2 13 with food and and those guys a day 3 times a day yeah and how do you work out how much insulin to take how much is the I drink for a while then I'll talk a bit more bit more to get it right and then you got the fennel I got the fennel how long have you had type 1 diabetes since 2012 and what cause have you come on do you know I don't know I don't really do to be fair yeah and tell me about your life more generally you live at home with you knee wife and daughter lovely how old is that well it was 23 alright cool yeah so that's it that age what age that's how I was that age yeah yeah yeah yeah that's alright fair enough alright fair and do you drink or smoke no no you're clean living kind of gas I've kind I I did drink years ago right I don't take I don't do it I'm all because I can't get pancreatic or people right so you have recurrent pancreatitis stuff yeah well you've got type 1 diabetes yeah and then I've got the you know so so this isn't really type 1 diabetes it's type 3 yeah diabetes absolutely so they call type 3 a yeah I think it's that so that's fine alright great can I have a little look at these allergic to anything I've got can't it yeah can not having that yeah okay quickly yeah heavy on and I'll keep you updated in terms of big breaths will every week yeah now that's lovely and again good to go okay so nice to do a chest nice normal heart sounds what operations have you had on your tummy oh keyhole operation take the gallbladder out yes now I had I don't remember what about for the study doctor charles so you have a typical yeah with the pines I've had it since I've had that enzyme thing I never I've had different different oh like it yeah yeah and you've got a libre sensor here in your tummy yeah that's not for me great yeah great alright and is your tummy sore at all no it's soft and long tapered no it's it's soft you sure that's not good and can I have a look at the legs any rashes there at all any pain passing water I've had some problems with my left feet so can I have a look at it yeah yeah it's I think it's healed up a big toe what did you do to it I hit it first and then it was like 4 blisters on there looks sore is it painful no no can I feel me touching the chest I've had that toe on for 13 days now because I was going back and it didn't tell well didn't go back so your right big toe looks a bit inflamed doesn't it yeah a little bit unhappy with an air it doesn't feel hot to touch so that's good yeah but there's an area of skin breakdown just on the medial aspect yeah can you feel me touching your feet not really not feet quite numb yeah alright thank you it's okay you got your socks back on yay your socks back on that's because I've anchored out great alright so I'll get the diabetic foot team to have a look at this first guide see if there's anything they can sort of last week say again I did say the foot peep glass great or say don't know what she's gonna be doing when she looked at it but I said that I wouldn't take it off what the coat the or the bandage the bandage because I said would just be worse then again of course yeah so alright well I guess I would have a look at the hip dressing on it okay yeah carry on the dka treatment with breakfast but with dinner you might be able to come off if your numbers look good okay the stop this drip so you don't have to have it overnight that's fantastic I'll restart you on your long acting insulin yeah do you feel dehydrated is your tongue okay yeah it should be a little we'll be you got a bit dry your tongue does look a bit dry we'll get you a bit more iv fluid alongside you to rehydrate you that's great and then thank you and then we'll take a left that sound alright yeah that sounds alright good it was nice to meet you lovely to meet you good job thank you

Issues:
1. Diabetic ketoacidosis (DKA)
- Patient ran out of long-acting insulin over the weekend
- Prescription delay - ordered over a week ago but not dispensed
- Has been managing with short-acting insulin only
- Currently on DKA treatment

2. Type 3 diabetes secondary to recurrent pancreatitis
- Diagnosed 2012
- History of recurrent pancreatitis
- Takes Lantus 60 units nocte and rapid-acting insulin 13 units TDS with meals
- Uses Libre sensor for glucose monitoring
- Takes pancreatic enzymes

3. Right big toe ulcer with possible infection
- Hit toe initially, developed blisters
- Area of skin breakdown on medial aspect of right big toe
- Mild inflammation present
- Dressed for 13 days
- Patient has diabetic neuropathy - reduced sensation in feet

Background:
Patient is a gentleman with Type 3 diabetes secondary to recurrent pancreatitis since 2012. Lives with wife and 23-year-old daughter. Non-smoker, stopped drinking years ago due to pancreatic issues. Previous cholecystectomy (keyhole). Currently admitted with DKA following interruption of long-acting insulin supply.

Examination findings:
Chest: Normal heart sounds, clear lung fields
Abdomen: Soft, non-tender. Previous laparoscopic cholecystectomy scars
Feet: Reduced sensation bilaterally (diabetic neuropathy). Right big toe with area of skin breakdown on medial aspect, mild inflammation but not hot to touch
Hydration: Tongue appears dry, clinically dehydrated

Impression:
1. Diabetic ketoacidosis secondary to insulin omission
2. Type 3 diabetes mellitus secondary to chronic pancreatitis
3. Right big toe ulcer with possible secondary infection
4. Diabetic peripheral neuropathy
5. Mild dehydration

Plan:
1. Continue DKA treatment protocol
2. Monitor blood glucose and ketones - may discontinue IV insulin if numbers improve by evening
3. Restart long-acting insulin (Lantus 60 units nocte)
4. Additional IV fluid for rehydration
5. Urgent diabetic foot team referral for right big toe assessment
6. Ensure adequate insulin prescription to prevent future DKA episodes

Summary

Investigations

Plans