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..
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