Stubborn PPBG in T2DM
A 64 year old male retired policeman with normally built, mildly overweight Chief Complaints He has no significant complaints. His fasting sugars are within the range, but also fluctuates somestime to 150 too. His main concern is PPBG which is in the range of 230 to 290 mg/dl His main concern is he dont wants too much of medicines Investigations As per recent HBA1C 2 months back, it was almost 7 % Management His treatment was - Metformin 1000 + Glimipiride 1mg BD, Voglibose 0.3 with lunch, Glargine Insulin 16 units 10pm, Tazloc Trio once daily, Urimax D H/S Today I have put him on - Glimipiride 2mg 15mins before bfast, Metformin 1000 + Vildagliptin 50mg BD after meals, Glargine 16 units SC and asked to follow up after 5 days Kindly give me your feedback on how to tackle stubborn PPBG?
I would use SGLT 2 Inhibitors They are effective, cardio protective, renoprotective, causes weight loss and controls blood sugar well Dapagliflozin, Canagliflozin They are critical in treatment of diabetes
PPBG- Repaglinide 0.5 B.D is very effective in PPBG. I am using routinely in PPBG along with metformin 500 mg ( Tab Volga - R ) I think - Continue Glargine 16 units and glimepiride and add Tab VOLGA - R - B.D and stop metformin + vildagliptin Endocrinologists - opinion will always help
LET'S GO WITH THE..SAME LINE OF T/T.. AND.. UNDER OBSERVATION FOR .. 3 TO 4 WKS.. NEED'S.. DIET PLAN.. SMALL.. FREQUENT..DIET.. FIBER RICH..FOOD.. NO..SUGAR ..LOWFAT..FOOD.. LOW CALORIE FOODS.. REGULAR EXERCISE..FOR 30 MINUTES..
Suggest Give glimipride 2 mg 15 minutes before food BD and Metformin SR 1g after meals. Voglibose with meals. This will control PPBG
Therapies such as mealtime insulin, thiazolidinediones (TZDs), DPP-4 inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and meglitinides (or glinides) provide exogenous insulin, stimulate endogenous insulin, increase insulin secretion, and/or suppress postprandial glucagon, thus improving PPG levels (1,7–11 ...
CST as given..
Cases that would interest you
- Login to View the image
male 45 years history DM2, hypertension, diabetic neuropathy, 15 days ago dipped his both feet in warm water, he did not realize that was boiling, positive culture for S. aureus, treatment? .
Dr. Anirudh Mishra3 Likes18 Answers - Login to View the image
84 year old with a lump in the right breast since 1 week. No history of trauma. O/e - 3*3 cm well defined firm lump in upper outer quadrant of right breast. Not fixed to skin or underlying muscle. No enlarged axillary LN. Share your views regarding the mammogram
Dr. Rohan Khandelwal11 Likes28 Answers - Login to View the image
c/o burn to a 70 year old non diabetic poor lady 15 day back in a remote village came to me today. this is present condition of wound o/e BP -140/80,, PR--80/min RS, cvs- WNL RBS-128 how to manage this case as she is poor and can't afford any procedure.
Dr. Amit Bhatia Chaurasia1 Like21 Answers - Login to View the image
54 year old female patient a known case of cad old asmi ,type 2 Dm, htn was admitted under diabetologist with abdominal pain ,found to have calculous cholecystitis was advised lap cholecystectomy by surgeon ,saw for surgical fitness pt had exertional angina also .I did cag for surgical fitness which showed SVD in lad critical.so far discussion how many would have stented then later gone for non cardiac surgery or how many would have done the other way ?
Dr. Vignesh Thanikgaivasan0 Like16 Answers - Login to View the image
sixty five years old female with squamous cell carcinoma of lower eyelid with involvement of eyeball with diabetes mellitus type 2 & hypertension for the last 5 years .please share your views regarding it's management .
Dr. Mukta Verma6 Likes18 Answers