Chronic Alcoholism with DM Type2

A 50 year old male who's a resident of nakrekal,labourer by occupation came to the opd to get admitted in de-addiction centre.

HOPI : 
Patient was appareantly asymptomatie 4 years back ,then he developed burning type of pain in the right and left hypochondrium,3 to 4 episodes for which he went to a local hospital and got medications(He's a chronic alcoholic), and the symptoms subsided, 1 year back he was found to have high Sugars at a government camp at his place used OHA's for 2 months & stopped medication for the next 2 months Then he developed complaints of Generalized weakness, polyuria for which he visited a private hosp at Nakrekal found to
Have high sugars.He was on insulin since then (took Insulin Irregularly) . Came to the Kims de-addiction centre for admission but they refered to medicine department for uncontrolled glucose levels(550mg/dl),10days back he had a history of minor injuries to legs which are not healing and associated with itching.

PAST HISTORY : 
K/c/o DM 2 since 1 year
Not a K/c/o Hypertension ,asthma ,CAD, epilepsy, hypothyroidism

PRESENT HISTORY
Daily routine :
He was a labourer by occupation.He wakes up at 6AM and does his personal activities,then he may or may not have alcohol (90ml) and goes to field work(agriculture) and comes to home at 9AM and have breakfast then he goes to labour work eats lunch at 1PM(if no labour work he drinks alcohol upto 90ml and sleeps after lunch) in evening he does his field work again and at night he drinks alcohol(90ml) and eats his dinner and sleeps at 9.00-9.30PM

PERSONAL HISTORY
Diet: mixed
Appetite: normal
Bowel and bladder movements :Normal
Sleep: adequate
No known allergies
Addictions : chronic alcholic since 30 years 

FAMILY HISTORY 
  No significant family history

TREATMENT HISTORY
   Was on glimiperide for 2 months after getting diagnosed with DM, and stopped using after that, later after 2 months He was on insulin,but was not taking insulin regularly.

GENERAL EXAMINATION
 •Patient is conscious, coherent, cooperative.
 Well built and moderatly nourished.
•No Pallor , Icterus,clubbing, cyanosis, lymphadenopathy, edema.
•VITALS 
Temp- Afebrile 
Bp-90/60 mm hg
PR- 82bpm
RR-18CPM
GRBS:258mg/dl

SYSTEMIC EXAMINATION:
RS- bilateral normal vesicular breath sounds are heard 
CVS : S1, S2 heard no murmurs 
P/A- soft and non tender,bowel sounds present 
CNS : No focal neurological defeicit 
HMF intact

INVESTIGATIONS : 
ECG
USG REPORT
PROVISIONAL DIAGNOSIS : 
Chronic Alcoholism & Uncontrolled Diabetes DM


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