Diabetic patient aged 56 yearsdiabetes since12 yearshypertensive, obese ,

dyslipidemicComplaining of palpitation, progressive

dyspnea,effort intolerance

Pain in the rt calf muscle on walking

medications

• Glipemeride 4mg OD/PO

• Metformin 500mg TID/PO

• ِِِ���atorvastatin 20 mg OD/PO

• Enalapril Hydrochlorothiazide 10/12.5 OD

• ASA 150 mg OD

• Cinnarazine 25mg OD

• Multivitamin Tab OD

Clinical data

• Bp 160/100

• Pulse 100 some extrasystole unfrequent

• Random sugar 210mg

• Wt 116 kilos

• Faint pulse on the rt foot Dorsalis pedis

• Bilateral LL soft pitting mild edema

LAB

• Hba1c 11

• Urine proteinuria

• Cholesterol 270

• Triglyceride 220

• HDL 35

• LDL 190

• UA 9

ECG

Do you want to ask patient any question

• Other Symptoms

• Chest pain

• Self monitoring

• Compliance

• Intermittent claudication

DD

• BP, Diabetes and lipid

• IHD

• PVD

Plan

• Proposed Investigations

• Cardiac assessment

• Peripheral vascular disease

• Metabolic control, diabetes, lipid

• Diet, improve control, compliance

• Health education , feet

Proposed medication

• Oral hypoglycemic

• Insulin

• Hypertension

• Dyslipidemia

• Heart cardiology consultation

• PVD vascular surgery