1. Review and discuss Pravin’s current mental well being.
2. Discuss Diabetic distress and management burnout.
3. Promote use of talking therapies and signpost where Pravin can receive additional support.
1. Assess the severity of Pravin’s foot ulcer.
2. Treatment of Pravin’s foot ulcer by selecting and applying the appropriate dressings.
3. Refer Pravin to a diabetic Podiatrist.
Pravin Kumar is a 40 year old gentleman who has type 2 diabetes and depression. Pravin has accessed talking therapies with good effect over the years and currently takes an anti-depressant called fluoxetine. Pravin has an elevated BMI of 29. Pravin has not attended regular appointments for his diabetes and is becoming increasingly isolated. His last HbA1C was done 6 months ago and was 63mmol/mol.
Presenting complaint– small ulcer on ball of left foot.
PMH– Depression diagnosed 6 years ago. Long term back pain following car accident which is controlled by analgesia. Type 2 diabetes diagnosed 2 years ago, hypertension.
Family History – father diabetes and heart disease
Social history – Pravin lives alone in a rented flat. Parents and sisters live nearby. Currently single. Works part time for the local council and has been off sick for the last 2 months. Does not drink alcohol. Smoker – 10 pack years.
General health – feeling very low in mood and feels very lethargic. Pravin meets with his community psychiatric nurse monthly who has recently encouraged him to join a local walking group to meet other people.
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