A 43-year-old male patient came for the management of diabetes mellitus to the Diabetes Centre KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, Karnataka, South India. He was diagnosed to have diabetes mellitus since 2 years. He presented with body pain, tiredness, and loss of bodyweight. There was no history hypertension, dyslipidemia, asthma, tuberculosis and any other medical illnesses such as alcoholic pancreatitis and hyperparathyroidism. His diet was irregular and erratic. He is a smoker and smokes 2-3 cigarettes a day. He has a history of having alcoholic drinks and beverages regularly, since 8 months he has stopped drinking.
General physical examination showed BMI - 20.56, PR - 80b/min, BP - 110/70 mmHg HbA1c - 15.4. Per abdomen, examination showed hepatomegaly.
Patient on further investigations and was started with premix insulin OHA and pancreatic enzyme supplements. The patient tolerated the combination well. On the day admission fasting plasma glucose was 339 mg/dl and 2 h postprandial plasma glucose was 503 mg/dl and HbA1c - 15.4%. After the following above administrations, his blood sugars were monitored 5 times in a day (FBS, PPBS, prelunch, predinner, and bedtime RBS) and there were no episodes of hypoglycemia. Laboratory investigations revealed that hemogram, LFT, kidney function tests, thyroid and lipid profile were within normal limits. Chest X-ray and ECG findings were normal.
Further, the patient was evaluated with CT scan of abdomen [Figures 3 and 4] it showed chronic calcific pancreatitis with dilated pancreatic duct with intramural calculi with hepatomegaly.
He is practicing storage of grains in the house with the enclosure of cow dung.