65 years old malay lady from tanjung keling who is a housewife has been suffering from diabetis for 20 years and hypertension for 10 years. She has been on haemodialysis for 2 years after
knowing to have renal failure through a routine blood check up by a clinic
near her house, though she didnt present at the time of diagnosis. She has
been taking oral medication for diabetis for about 15 years and has started
using the insulin injection for twice daily after being found to have
persistent high glucose level by the diabetic clinic in peringgit for almost
five years.lately she has been advised to take once daily as her blood
glucose is under controlled compared to previous records.All her medical
expanses is supported by government through his son quota who is now working
with ministry of health. The other expanses such as transportation expenses
to the dialysis center etc are taken care by her youngest daughter who is
currently staying with her. She has 8 children all together and her husband
has passed away 23 years ago due to heart complication of uncontrolled
diabetes.

She attained menopause at the age of 40.since then she developed back pain
when walking, might be due to osteoporosis. But she managed to do normal
daily activity, and perform her prayer as usual. There is a history of leg
ulcer 3 years back on her right lower limb which has left a scar after which
she had her dressing done at that time and was admitted due to anemia due to
loss of blood through the open wound. There was also panretinal laser
photocoagulation done on both eye due to proliferative neuropathy 3 years
ago.

Ever since she did her fistula surgery, she developed a left upper limb
weakness. she claimed that her left hand easily get cyanosed if exposed to
cold and there is present of hypoesthesia of all the distal limbs (gloves and
stocking involvement since past 10 years where she is unable to use a normal
gripping sandals and require a 'slip on' sandals).

She said that she has no control on her diet though was advised by the
physicians, as for her, she believes that the more restricted food, the more
suffering u are. I couldn’t elicit any relevant family history in her as she
goes thru a unique life as her parents passed away since she was small
during the communism riot. This is one of the important event which ever
takes place in her life where she and her 2 other siblings were under the
guidance of her aunt since small till they were separated at the age of 6 to
separate foster parents as her aunt couldn’t afford to look after them. She
only knew that she's an adopted child when she reached the age of 20 when an
identification card registration requires a valid birth cert, which her
foster parents failed to produce. From that moment she decided to
search for her other 2 siblings who she was unaware of.  Only late 40 years
of age that she got the chance to met them, before they passed away. If were
asked about the most important person in her life they were her siblings as
they managed to still survive though with hurdles they've undergone without
own identity after the lost of their parents.

She claimed that she has never gone to school before. She didn’t really feel
any burden of the dialysis treatment as she has nothing to do at home other
than taking care of her grand children aged 1 1/2 years old.as for the other
chores, it has been taken care by her youngest daughter.

on examination, the patient is conscious and co operative, she is well built
and well nourished. there is no pallor and no icterus.there are arcus senilis
and multiple peripheral laser burns in both eyes. there are no peripheral
cyanosis but the patient covers up her left upper limb as to prevent
exposure to cold and there is a fistula on the same arm.A scar measuring 5
cm can be seen between 1st and 2nd metatarsals of right foot.abdominal
examination couldnt be performed.

on investigation,her renal function test ;
                                                  creatinine
194mmol/L(Increasing)
                                                   uric acid 126
mmol/L(increasing)
                            liver function test ;
                                                   potassium 2.6
mmol/L(decreasing)
                                                   chloride 97 mmol/L
(decreasing)

treatment given so far
                             metaprolol
                             caco3
                             vit B 12
                             Folic acid
                             Feso4

Norfazlin Zamani-8th Semester