44 yr male with history of diabetes and hypertension on Telma H and T Glynase MF. OBESEITY present. Pls see the reports and discuss the management

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Thanks for tagging me Dr Govvinda . This is a case of Type 2 DM, Hypertension, obesity and Dyslipidemia. As per HbA1C ,his glycemic control is good, but Fasting blood glucose is high and not correlating with HbA1C. So repeat blood sugars fasting and post prandial blood sugars and HbA1C. Marginal elevation of SGPT is not significant. Do the following investigations for follow up. CBP FBG PPG HbA1C RFT TFT to rule out Hypothyroidism LFT Serum electrolytes Viral serology Micralbuminuria Fasting lipid profile 12 lead ECG to rule out CAD 2D Echo if any abnormality found in ECG USG abdomen and pelvis to rule out Fatty liver/ NASH. Coming to the treatment 1) LSM 2) TLC 3) Counseling the patient regarding his comorbidities and future complications . 4) More on diet and exercise. 5) How is blood pressure,is it under control? 6)Replace hydrochlorothiazide with Chlorthalidone as it has cardiovascular benefits and continue Telmisartan. 7)Add tablet vildagliptin 50 mg plus Metformin 500 mg bd to control his blood sugars and body weight. 2 gms Metformin will help in reducing weight. 8)Add tablet Rosuvastatin 20 mg plus Fenofibrate 160 mg for dyslipidemia. 9)Add one tablet of Methylcobalamin 1500 mcg to prevent neuropathy either due to Diabetes or Metformin induced. 10) Reduction of 7% of his body weight reduce complications.

Uncontrolled DM with mixed dyslipidemia & high SGPT Complete LFT to be done. Though you have mentioned the medications but no mention about doses. A night shot of IGlar or IDeg at 10pm will be helpful to control DM as it seems (having high FPG) Start with a low dose of Statin keeping in mind about high SGPT.

PATIENT 44 YEARS OLD HAS DM AND HYPERTENSION AND OBESITY OBESITY IS HIS GREATEST RISK FACTOR WITH ALREADY EXISTING DM AND HYPERTENSION OBESITY IS A RISK FACTOR FOR DIABETIC RETINOPATHY A R M D C R V O GLAUCOMA ALSO CAN BE A RISK FACTOR FOR STROKE VISUAL IMPAIRMENT FLOPPY LID SYNDROME AND THRIOD DESEASE

Pt is obese and having fasting hyperglycemia Pp is not available Hba1c is 7.1% Dislipidimia This all suggest pt need to change lifestyle and reduce the weight So far OHA is concerned Will advise Rx tab metformin sr 500mg bbf Tab glycomet GM 1 1bd befor meals Tab dapagliflozin 10mg 1od Review after 1month But correction of BMI and Diet modification are important steps

Known pt of hypertension & diabetes mellitus Stop glicazide side effect is weight gain put on sglt2 drugs 60 to100 gm of glucose cleared in urine so loss of wt Hypercholestremia Hyperlipedemia put on atorva40 od target LDL to below100 For triglycerides fibrats bring down to100 ideal Diabetic diet Walking 40 minutes brisk

The person diabetes is in fair control but hypercholesterolemia is present. So statins must be added to his treatment. Reffered to opthalmologist for fundus examination to rule out diabetic and hypertensive retinopathy. LFT showing higher SGPT ,do reffer him to general physician to manage the drugs.

Only cholesterol and triglyceride are increased adjust your diet

Add tab canagliflozosin 100 1/2 od and tab rosuvastatin and aspirin

Best option GLP 1 RA
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Poor HBA1C CONTROL.. STRICT DIET CONTROL TENGLYN 20MG OD

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