Management of steroid induced hyperglycemia in COVID 19 patients .during and after discharge?
Steroids induce insulin resistance by directly interfering with signaling cascades, mainly the GLUT4 transporter, within muscle cells, with the subsequent 30%-50% reduction in insulin-stimulated glucose uptake and a 70% reduction in insulin-stimulated glycogen synthesis. On the other hand, steroids are responsible for the catabolism of proteins with the subsequent increase in serum amino acids, which also interfere with insulin signaling in the muscle cell. Finally, they increase lipolysis, resulting in an increase in serum free fatty acids and triglycerides. These promote the accumulation of intramyocellular lipids (acetyl coenzyme A, diacylglycerol and ceramide), reducing the entry and storage of intramuscular glucose. the best treatment the first consideration to make is whether to use oral hypoglycemic drugs or insulin**
Please read my article on benefit of insulin for treatment of Covid 19 https://jmscr.igmpublication.org/home/index.php/archive/178-volume-08-issue-07-july-2020/9517-use-of-insulin-in-treatment-of-covid-19-a-proposal-to-explore-feasibility Certainly insulin is best option for treatment of hyperglycaemia!
dexamethasone therapy
DPP4 INHIBITORS SLGT2 INHIBITORS INSULINS
Insulin is the best option. U can slowly shift to OAD after discharge
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73 years old, female patient. She has diabetes and high blood pressure.There are 15 days the lesions (pictures) emerged on the internal area of the right thigh and it spread to the lower area and sacral area. What’s the probable diagnosis?
Dr. Ram Mohan3 Likes21 Answers - Login to View the image
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Dr. Prasanth Sasidharan3 Likes19 Answers - Login to View the image
56 years old female with 18 history of diabetes and high blood pressure in management with insulin and losartan with no major cardiovascular events at this time. She's been complaining of this problem one week ago, this lesions started in the groins and now there are in her armpit, arms nach chest. This lesions start like the first picture and suddenly take the appareance of the second one, are painful. The whole skin examination shows nothing more. What's your suspicions?
Dr. Rama Chauhan0 Like16 Answers - Login to View the image
A 60 yr old male who is a known Diabetic since 10 yrs on OHA and diagnosed as having Pulmonary TB 2 montgs back and started on ATT presented to us with complaints of Loose motions with one episode of PR bleed since 1 day and Altered Sensorium since 3 hrs...At presentation, BP- 190/120 PR-70 spO2- 87 RBS- 450....Severe Pallor was present...No previous history of bleeding from any sute was present....MRI Brain showed Acute Infarct....Ketones were negative...Discuss the approach to this patient
Dr. Hardik Ahuja7 Likes16 Answers - Login to View the image
patient is diabetic sice 20 years female age 70 plus what is this condition on her hand skin dries up and peels off diagnosis please
Dr. Suhel Lokhandwala0 Like23 Answers