54 Female weighing 90kg known HTN came with a c/o intermittent fever with chills on and off. Test for Malaria under microscope negative. Salmonella negative. H/o Burning micturition 3weeks back and having vaginitis as i understood by her words. Complete urine analysis - lot many pus cells. Urine sent for culture. Immediately she was started on Glevo 500 daily once for 1 week and Niftas 100 mg twice daily for 7days blood investigations further revealed FBG 260 PPBG 330 S URIC ACID - 6.3 LFT NORMAL BLOOD UREA AND S CREATININE WITHIN NORMAL LIMITS FASTING LIPID PROFILE - TGL 360 Total Cholesterol - 214 VLDL 72 HbA1c 12.4 Thyroid profile and urine for ketones - Waiting As this is freshly diagnosed dm case whats the next step of management? Apart from lipid lowering agents Shall we start with metformin and sitagliptin/Glimepiride or Insulin have to be started immediately with the above drugs combination ?

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Urine for ketones is must. Metformin is drug of choice along with dpp4 Inhibitors. If no ketoacidosis, add Glimipride and bolus insulin. Monitor blood sugar and adjust the doses accordingly

Thank you doctor
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Start with OHA...And symptomatic for other symptoms ,and antibiotics you was started are enough for infection,but if not subside then start injectable mikacin 500mg bid for 5 days

Metformin plus antibiotics for uti

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