Diabetes after the necrotising pancreatitis

38yr male has history of more than 50% necrotising pancreatits 21 days back.got his sugar level elevated.put on insulin in hospital.he was kept on metformin 500mg bd on discharge.still the sugar uncontrol.drugs glimperide 1mg bd added .still the sugar uncontrol.now how to manage.does it respond oha

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My prescription will be Insulin likely inj degludecAsP 10units or titration as per requirement Metformin 500mg /1000mg bd SGLT 2I like dapa 10mg or 20mg od I will not put on glimiperide as this molecule occupies beta cell receptors more permanently and causes insulin resistance ie beta cell apoptosis In a pt who has already exhausted beta cells and a c/o necrotising I hope this will give better control SGLT2I will reduce the sugar levels and will minimise the requirement of insulin units and give you better reduction of hba1c
Thanx dr Pushkar ji Bhomia
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DAMAGE TO PANCREAS INSULIN SECREATING AREA( ISLET OF LANGERHANS ) .DRUGS WHICH ACTS ON STIMULATING INSULIN SECRETING CELLS = ( SECRETAGOUGES ) = GLIMEPERIDE = WILL NOT HELP METFORMIN = ACTS BY REMOVING INSULIN RESISTANCE WHEN THERE NO INSULIN = WHERE IT WILL ACT PT IS NOW INSULIN DEPENDENT DM = INJ INSULIN IS TO BE GIVEN & CONTINUED
do we need to stop metformin sir
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SUGGESTIVE OF TYPE. .. ...3- C. ...D. M SECONDARY. TO.. NECROTIZING PANCREATITIS... ADVISABLE 1. EMPIRICAL. TREATMENT 2. METFORMIN 3. INSULIN 4. HIGH. DOSE. VIT. D 5. MULTIVIT
Insulin need to be started In mixtard BD
Put him on insulin

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