This patient is a known diabetic and hypertensive for the past 18 years. She has been on regular use of dialysis for the past 1 year, 3 times a week for 4 hours. When diagnosed with both DM and Hypertension 18 years ago she was started with oral medication  which she was not compliant with. It was only about 2 years back she was started with insulin treatment twice a day. She is compliant with this treatment and self administers this drug twice a day in the region of her abdomen, before meals. It was during this time when she had many episodes of fainting, vomiting and complained of swelling of her feet. She also noticed that her urine output had progressively decreased over a span of few months. The swelling began to affect her whole body and was soon visible in the periorbital region every morning when she gets up from sleep. She also had associated symptoms of breathlessness( grade 2), nausea and vomiting.
 
On subsequent visits to her doctor it was then diagnosed that she had chronic renal failure and was advised to undergo dialysis. She is regular with her treatment. Her husband , a retired air force commander drives her to the dialysis center which is located about 10km from her house. The cost of the treatment is fully covered by the government as part of their incentives of free medical treatment to all government   servants and their families. The treatment has not affected her daily routine of life. Even before treatment she would spend her time sleeping or watching television. She is glad that she has been given this opportunity to seek treatment of a very serious disease.
 
On family history, she is the first to have developed CRF among her 3 siblings. All her siblings and her mother(deceased) suffer from DM.
 
on examination the patient is very much alert and cooperative. her vital signs are stable. there is a AV fistula in her left cubital fossa which connects to the dialysis.

Shashank Raghu 8th Sem