A 63 years old (y/o) Malay lady who was a teacher came to the Peringgit Polyclinic for her routine blood sugar check-up. She is a known case of non-insulin dependent diabetes mellitus (NIDDM) since 15 years and hypertension for 10 years. She took tablets medication for both conditions. She had undergone cataract surgery on her right (R) eye last year. Currently, she complaints of non-healing ulcer at left (L) leg for 7 days without notification for any preceding trauma.
 
On examination:
 
There was mild pallor at lower palpebral conjuctiva of both eyes. Eyes examination indicates posterior chamber intraocular lens (PCIOL) at the (R) eye with mature cataract on the (L) eye. Ophthalmoscopy showing old laser panretinal photocoagulation (PRP) scar in the (R) eye and absent of red glow on the (L) eye. There was single, regular leg ulcer at her (L) foot at calcaneal region, measuring about 0.5-1cm with well-defined margin associate with moderate amount of purulent discharge and a bit tender upon touch. There were  swelling and erythema at the calcaneum particularly around the ulcer region. No gangrene was found. There were impaired crude and light touch at the (R) foot and worse on the (L) foot extending to the ankle.
 
Provisional diagnosis: (L) foot diabetic ulcer and mature diabetic (L) eye cataract with NIDDM and PCIOL on (R) eye.
 
Exploring personal and social background :
 
Patient had a strong history of NIDDM in her family where her mother, 2 elder brothers and her sister had NIDDM. One of her brother died due to renal failure and another one also had undergone cataract surgery on his (R) eye about 5 years back. Previously, she was an active lady. She loves gardening, stitching, sewing clothes for her husband and children, and cooking. She usually took heavy meals consist of rice for 3 times per day.At school, she likes to participate in any in-door and out-door activities; she also involves in malay woman organization at her place. It was at the age of 53 when she got NIDDM, she became less active. She easily got fatique since then and she stopped involving in the organization. The condition became worse when she had gradual onset blurring of vision. She stopped stitching and sewing clothes (now for grandchildren) feeling afraid that she might injure her fingers, which may lead to amputation. She slowed down her gardening activity with the same reason-she didn’t want to get injured and been amputated though her vision did improve a bit after the cataract surgery. Currently, she is staying with her married daughter and grandchildren. All the house chores had been taken care of by her daughter. Last 2 months, she easily got hungry and took 4 heavy meals per day. Since then, her blood glucose level became less controlled. Last 9 days, they went for a picnic at the beach. She claimed could not remember anything regarding any preceding trauma to her foot nor any altered sensation to her feet. Currently, she is waiting for her turn to meet doctor.
 
Maisarah,8th Sem