Pre diabetic patient wishing to control blood sugar by changing their lifestyle

NOTE: THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.

Age – 33

Sex – Male

Height – 164 cm

Weight – 89 kgs

BMI – 33.1

Patient expectations/goals – To control his diabetes via a change in lifestyle and food habit

PATIENT HISTORY:

The patient is a 33-year-old male, who works in an IT firm. The patient is reported to be bulky and overweight since childhood. Used to suffer from multiple episodes of fever during childhood. At the age of 7 got a tonsillectomy done. Engaged in sports activities during teenage life. During class 9 suffered from jaundice which got resolved with medications. Started smoking 1-2 cigarettes/day when in boarding school during class 10, due to peer pressure. During college life 1 packet/day. Started alcohol consumption in the first year of college life around 2-3 pegs/wk or monthly. Sometimes even half a bottle at one go. Complaint of cough with sputum after heavy smoking between 2015 and 2017. So, did TB test in 2016. Result -ve. In 2017, due to family pressure tried giving up smoking but after abstinence for 1 month 17 days took 1 cigarette, failing to stop it afterward. In 2017, during a normal health checkup FBS 90 and PP 160. Got married in 2018, after which occasional drinker(1 - 2 pegs). In 2019, pain in the upper right side of the abdomen. Diagnosed with fatty liver grade 2 and PP 180. Told to be prediabetic. Started eating boiled vegetables and exercising. Reduced consuming fast food. In 2020, visited the clinician and was recommended 500mg Metformin half tab. o.d. Stopped after 2 months due to fear of side effects and drug dependency. 7 months ago PP 210 and FBS 105, wt 82kg. Started going to the gym( breakfast - oats, lemon, cucumber. Lunch - rice, veg. chicken, fish, Dinner - 3 roti, veg. chicken). Did not smoke or drink during that time period. 4 months ago did PP 145 and FBS100. Thinking he is getting well started on heavy smoking( 1 - 2 packs/day), and alcohol(1 quarter 3-4 days per wk). 1 wk ago did PP 276 and FBS 139. 3 days ago did HbA1C 6.9. The patient loves to eat spicy and fatty foods but gave up for the past 1 wk. The patient claims to feel energetic after doing exercise. No complaints of SOB, headache, or any other complaints except lethargy. Complaints of extreme mental stress and tension due to work for a long time. Can't concentrate on the screen for a long duration because eyes turn reddish. Habit of overthinking from a young age.

Daily routine for the past 1wk:

7 am: wake up

Giloy juice one cup sometimes

Jogging, aerobic exercise from 7:15 - 8 am

Breakfast : at 9am(roti, Maggi,dosa,idli)

9:30 am to approx 7pm: office work(sitting in front of the laptop)

The patient is working from home for the last 2 years

In between work takes 3 - 4 breaks(smokes cigarettes 1/break)

6pm: snacks (fast-food - especially momos)

6pm -10pm : office work

9:30 pm : dinner(roti,veg,chicken)

Family history: Father was a heavy smoker for 45 yrs, had a history of HTN, and 55-year long history of diabetes(under control). Died at the age of 65 due to a brain stroke. Used to skip BP medications. He was bulky and his family tree was full of patients suffering from heart ailments. The mother is of normal build and has no known ailments. The patient has 2 siblings. His sister(age - 30) suffers from hypothyroidism, bulky built. His younger brother(age -27) is of normal build and does daily exercise.

Q AND A:

Q. Does he like and enjoy what he is doing?

Ans. Patient claims to be satisfied and happy with the work he is being told to do. Admits there is a huge workload and tough targets to be achieved within the given time. But he claims to love taking on challenges and is willing to take the pressure. But he also claims that earlier he felt as if he was sharper in making decisions but now feels a bit dull.

Q. Is he able to cope with the task at his work?

Ans. He claims to achieve the targets given to him most of the time. Sometimes due to a high workload fills as cannot make decisions or concentrate. Then takes short breaks, watches youtube videos, movies, Facebook, and smokes.

Q. Is he able to maintain a work-life balance?

Ans. The patient claims since his wife also work hence she is very understanding. But claims that if he could have asked for one wish he would have wished to go to the top of a mountain, smoke, and relax.

Q. What is causing him to overthink?

Ans. i) Monetary factor: Not much satisfied with the salary. Short of money due to unforeseen expenses. Not sure how and from where to save money to secure their future. He is planning to have a child soon. But thinks the money they earn is not enough to secure their future.

ii) Work: No job security. Huge workload. He feels the time is short and does multitask which reduces his efficiency at work. Cannot concentrate on one thing at a time like thinking about family-related matters while doing work.

iii) Family tension: He claims to have been very short temper at the age of 20 - 28 and would talk aggressively over trivial minor issues. But claims to have changed after self-realization and maturity. Sister is divorced, he worries about her future since his father is no more.

Q. Marital life?

Ans. He is satisfied with his marital life. His wife(who also works in IT same place but a different company) is very understanding. Feel sometimes that it would have been better if u could have spent some more time together, which maybe u cannot because of both of ur workloads?

Q. Sexual life?

Ans. He feels the density of his semen has decreased than before. Also, his desire for sex has decreased. He is worried and wishes to visit a clinician because now they are planning to have a baby. He claims that he feels that the density increases if he exercises.

Q. Lifestyle?

Ans. In college life, he preferred to complete his work at the last moment. During college life before exams spent 2-3 sleepless nights. Used to work till late at night at 1am even a few months back. Struggled to go to sleep and hence would watch movies late at night. But now goes to sleep at 12am even if work is left incomplete.

Q. Thoughts and beliefs?

Ans. Not a great devotee of God. But feels mental relaxation and peace during prayer. He feels he is becoming slow and dull and cannot find solutions to problems related to his work and life. He feels happy to do challenging work. Feels he will not be able to live for another 15 years. He fluctuates in decision-making and changes his decision at the last min. He loves to eat and smoke. Couldn't stop himself from smoking at least once in a while. He lacks consistency in following his food and exercise routine. Claims to have realized that he needs to give up smoking, spicy and oily food, do exercise.

REPORTS:

23.9.21 HbA1C -5.8