A 23 y/o chinese man who was a mechanic came to the polyclinic for his routine blood check-up. He is a known case of insulin dependent diabetes mellitus (IDDM) for 10 years and hypertension for 1 year. He did complaints of mild puffiness of his eyes in the morning since last 2 days.
 
On examination :
 
There were moderately pallor of his lower palpebral conjunctiva of eyes and hands. No oedema noted. Pulse rate is 96 beats/min. Blood pressure is 130/100mmHg taken on right arm in sitting position. Abdominal examination cannot be performed.
 
Provisional diagnosis : Type I diabetes with ?nephropathy
 
Exploring personal and social background :
 
He is the first child among 3 siblings. He is the only child who has IDDM. He was apparently healthy when he was in primary school. He loves eating chocolate, ice cream and junk food. He loves sport but felt he was not good in it and thought it could be because he was not fit and easily got tired. He was moderately intelligent in school, a bit quiet and loved to mingle around with friends. It was when he was 13 y/o where he suddenly got fainted at school. As he was not recovered from the fainting, he was sent to the hospital where he was diagnosed to have IDDM. Since then, there was a change in his life. At first, he refuses to do the insulin injection himself. He felt afraid and became denial of his condition. So, the mother took the task. Later, he did it himself but because he always forgot and missed the injection, he frequently fainted at school particularly during assembly and sport day where he became a supporter and spectator to his friends who were involved. Those incidences ashamed him so much since he felt that boy should be tough and macho; not like a girl who easily got collapsed. He became depressed. His concentration in learning also decreases which brought down his study performance. Feeling that he had a disease, which cannot be cured and he was not that intelligent, he refused to further his study after completion his secondary school. He becomes a mechanic and helping his father at the workshop. He does still mingle around with his friends who understand and support him much but he felt a bit inferior to girls regarding his condition. Last year, he was diagnosed to have hypertension, which is on oral medication.

Maisarah,8th Sem