Concluded Case

Pt name xyz comes with frequency of micturtion advise hba1c very high

Good morning drs one of my pt age 50 having frequency of micturtion excessive thirst since 10 day blood test urine test done ..freshly detected dm non htn pleas sugest me ant dibetic medicine and doses

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This is a case of uncontrcolled symptomatic newly detected Type 2 DM . Do the followinginvestigations before starting treatment. FPG PPG HbA1C RFT Lipid profile LFT CBP TFT Serum electrolytes Micralbuminuria CUE ECG. Ketone bodies in urine and blood. Treatment depends on whether the patient is in DKA or not. If he is in DKA,drug of choice is only regular insulin. Advice admission ,if he is not willing for admission, start regular insulin three times a day and correct dyselectrolytemia if any by giving plenty of oral fluids with salt or ORS sachets or IV fluids NS. Treat if there is any associated infection with antibiotics. Vitamin supplements. If patient is not in DKA, not willing for insulin, Bedrest for initial period atleast 10 days. Plenty of oral fluids with salt. Start with Tablet Glimipiride 2 mg plus Metformin 500 mg bid DPP4 Inhibitors like Linagliptin 5 mg od. Low dose of Pioglitazone 7.5 mg if there are no contraindications. SGLT2 Inhibitors can further induce osmotic diuresis and dehydration, so i can not recommend it at this stage until his dehydration is corrected and renal function is good . Treat other associated factors like Dyslipidemia, Hypothyroidism and Hypertension ,etc. Last and most important is LSM and TLC
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This is a case of uncontrcolled symptomatic newly detected Type 2 DM . Do the followinginvestigations before starting treatment. FPG PPG HbA1C RFT Lipid profile LFT CBP TFT Serum electrolytes Micralbuminuria CUE ECG. Ketone bodies in urine and blood. Treatment depends on whether the patient is in DKA or not. If he is in DKA,drug of choice is only regular insulin. Advice admission ,if he is not willing for admission, start regular insulin three times a day and correct dyselectrolytemia if any by giving plenty of oral fluids with salt or ORS sachets or IV fluids NS. Treat if there is any associated infection with antibiotics. Vitamin supplements. If patient is not in DKA, not willing for insulin, Bedrest for initial period atleast 10 days. Plenty of oral fluids with salt. Start with Tablet Glimipiride 2 mg plus Metformin 500 mg bid DPP4 Inhibitors like Linagliptin 5 mg od. Low dose of Pioglitazone 7.5 mg if there are no contraindications. SGLT2 Inhibitors can further induce osmotic diuresis and dehydration, so i can not recommend it at this stage until his dehydration is corrected and renal function is good . Treat other associated factors like Dyslipidemia, Hypothyroidism and Hypertension ,etc. Last and most important is LSM and TLC
Thank you doctor
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Newly detected diabetic Hba1c is 12.1 is quite high So also bsl levels f 250 suggest pt is likely heridetory diabetic type 1 If pt is obese and overweight He should be advised to reduce and control the same Change in lifestyle and daily exercises are utmost necessary Diet to be advised is keto diet ie low carbohydrate and low fat normal or high protein diet So far Rx is concerned He is a fit case for insulin OHA tab glimiperide 2mg+metformin 500mg +,voglibose 0.3 mg Tab dapagliflozin 20mg 1od Keep monitoring and followup
Thank you doctor
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