uncontrolled Diabetes

A pt aged 35 yr having Diabetes fasting 198 and 2hr pp 398mg/dl. Started on metformin 500+glimperide 1+pioglitazone 15mg.but still reading are almost same. Than add Metformin+glipizide.but still reading are almost same. What to do next! Should shift on insulin ?? Patient unable to get hbA1c.bcz pt is poor and I m working in periphery

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The way you are telling the history seems like its uncontrolled sugar.. There are two ways to approach this Either to add multiple OHA's or go for insulin As pt is from periphery, they will not prefer or may not be long term compliant with insulin.. Add glimeperide upto 6mg /day with metformin & pioglitazone max 30mg/day Wait for atleast 15 days Add gliptin for more control if req

Young adult diagnosed with DM require a detailed investigation including Sr Insulin, C-Peptide, HbA1c & GAD-65 Ab. LADA to be ruled out. Better to start with insulin to prevent glucotoxicity.

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NEED'S.. HBA1C .. INSULIN .. OHA.. ENDOCRINOLOGIST OPINION.. STRICT GLYCEMIC CONTROL.. DIET PLAN.. REGULAR EXERCISE..

Thank you doctor
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Diet, exercise and insulin is the only answer

Thanks Dr. Sandeep Ghodeker, Dr. Kute Ankush ,Dr Pushker Bhomia,Dr. Ashok Verma,Dr.Dinesh Gupta, Dr. Irfan Khan
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Definitely can consider insulin therapy earlier..

Check for compliance.Did you wait for at least a month before cheking blood sugar after tablets are started?

Start with Tab Triglynase 2 forte BD. This one the patient may afford. See the patient after 2 weeks. Reinforce drug adherence and diet.

Assurance and psychotherapy Diet plan and exercise with brisk walking 5 km Continue same medicine for 20 days With methylcobalamin 1500 OD Assessment of daily diet and reduce it

Inj Insulin Diabetic diet Brisk walk Exercise

@Akram Khan

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