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Abstract
A 65-year-old patient with background of alcohol excess and previous gunshot wounds was admitted with significant weight loss, leg cramps, dizziness and lethargy for the last 3 months. He was diagnosed with type 2 diabetes mellitus in July 2020 and was started on Metformin and Gliclazide by his in July; he was later commenced on alogliptin and empaglaflozin by diabetes specialist nurse in early August. He also had generalised muscle wasting, dorsal guttering in both hands and was cachectic when he presented to hospital. His haemoglobin A1c (HbA1c) was 124 mmol/mol in July 2020 and was 63 mmol/mol in September 2020. The patient had negative autoimmune and TB screen. CT abdomen/pelvis and CT lumbosacral spine that showed mild diverticular disease and bilateral L5 spondylolysis with L5-S1 spondylotic changes. Electrophysiological studies confirmed sensory motor peripheral neuropathy. Patient was diagnosed with diabetic neuropathic cachexia secondary to poorly controlled diabetes and was commenced on 30 units two times per day of NovoMix 30 insulin; this was adjusted to 24 units two times per day in endocrine clinic 3 months later, after gaining 10 kg in weight. Good glycaemic control is key to the management of such cases and, therefore, we recommend early referral to diabetes specialist input for consideration of insulin therapy.
- diabetes
- depressive disorder
- pain (neurology)
- endocrine system
- neurology
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Footnotes
Contributors ZUK consented the patient and did literature search and wrote the case report myself. I was also involved in the management of the patient and reviewed the patient. I also gathered the data with the help of KM. I also requested KM to kindly request those investigations and has Neurology review for the patient. I also designed the case report and made changes suggested by BMJ admin team and got help from KM to kindly collect the patient and partner perspective for the purpose of case report. NG reviewed the article and helped me in finalising it. He also helped me in the initial diagnosis of the patient and he was also present during the consenting process. He also helped me in writing the final case report and also helped in management of this patient by advising the appropriate diabetic treatment and investigations required. He also helped in the analysis of the data and suggested writing the case report. KM was involved in the patient management and took the detailed patient history including past medical history for the purpose of case report. She also helped in getting the patient and partner perspective for the case report. She also helped me in arranging the investigations for this patient advised by NG and chased Neurology review for us and also collected the reports for us. She was also involved in writing the findings of the patient when we examined the patient for the purpose of case report. She also reviewed the final case report and was happy with the final case report.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.