NDD in Diabetic patient w...

A 58-year-old married man visited his family physician for a regular diabetic check-up. He has had H/o diabetes for four years with mild obesity and hypertension. His BMI was 30.4 kg/m2 and BP 165/92 mmHg. Despite using insulin, he faced uncontrolled hyperglycemia recently with an HBA1c level of 11.2%.

The patient has developed difficulty falling and staying asleep for six months, making him less socially active and mildly obese. He denied feeling depressed but eventually lost interest in work, sexual activity and faced trouble concentrating, which made him irritable and frustrated. Physical examination, Routine laboratory and CT scan of the head were all regular. The patient was prescribed alprazolam, which relieved insomnia but had no effect on his other symptoms.