T2DM witb Hypothyroidism with DOE and at rest

A 45 years old female obese housewife presented to OPD Chief Complaints Her complaints are excessive tiredness and dyspnea on exertion and at rest too Investigations Electrolytes - Na,K etc are normal S.Cr, S. Urea, Uric acid all are normal HbA1C - 8 % RBS - 130 CBC done today revealed Hb of 9 gm% Before when she reported few days back her RBS was 286 She added her TSH was fine which she repeated 15 days back, so as per her admission, I didn't repeat TSH 2D echo is pending which will be done out of station Management I had started her on Gliptins + Metformin for T2DM, I had started her on Torsinex Plus 10/25 in morning, Bisoprolol 2.5 mg OD, My further line of management would be - 1) As I am suspecting her as a case of heart failure with preserved or reduced ejection fraction and associated anemia, I am planning to supplement her IV Iron Sucrose ? 2) As she is complaining of excessive tiredness/fatigue, do u recommend on adding SGLT 2 Inhibitors like Dapa or Empa? 3) Should I titrate the dose of Beta blocker further? Titrate diuretics too? Add Acei/ARB?

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@dr Ajeet Pal Singh No where her status is given so shift from this molecule to another molecule is not a wise step First evaluate and workout in detail to confirm that pt is in failure it is difficult to understand without ecg 2decho and xray chest of course clinical examination is most important However we cannot rely on just statement of pt that her tsh is fine let's know what are the figures Even diabetic status is not good order for hba1c Study KFTS and r/o DKA

While shortness of breath is the most common symptom of heart failure, it may be difficult or impossible to distinguish it from shortness of breath caused by other health problems such as emphysema or severe anemia. You can help you determine why you have been feeling short of breath. People with heart failure experience shortness of breath in many different ways. You might feel that: You can't catch your breath. You feel tightness in your chest. You feel tired when you walk. You need to stop a lot when you walk. It gets worse when you lie flat, and it may wake you up at night. Shortness of breath from exertion or exercise. If your shortness of breath isn't severe, you may notice it only when you are exerting yourself, and sometimes only during more intense exertion. The medical term for this symptom is dyspnea When heart failure develops gradually, your shortness of breath also may develop gradually, which can make it hard to notice. But people with more severe heart failure may have shortness of breath with minimal exertion. Shortness of breath while lying down. People with more severe heart failure may experience shortness of breath when they lie down. The medical term for this symptom is orthopnea . The severity of this symptom usually depends on how flat you are lying—the flatter you lie, the more you feel short of breath. To gauge the severity of this symptom, doctors often ask people how many pillows they need to lie on to avoid feeling short of breath in bed. For example, "three-pillow" orthopnea is worse than "two-pillow" orthopnea, because you have less tolerance for lying flat. The reason you may have orthopnea is that when you lie flat, the blood that ordinarily pools in the veins of your legs is reentering your bloodstream. If you have heart failure, your heart may not be able to keep up with the increased amount of blood returning to the heart, so fluid builds up inside the lungs and causes shortness of breath. Shortness of breath while sleeping. Some people with heart failure wake up in the middle of the night with severe shortness of breath. The medical term for this symptom is paroxysmal nocturnal dyspnea (PND). This may occur with waking up coughing and/or wheezing, having a rapid heart rate, and a feeling of being suffocated.

Anemia & diabetes are cause of fatigue Strict control of diabetes Correct anemia

Add probnp 2 decho Sgl2 good drug Both for diabetes & heart related

As today Rbs is 230, u should not change the dm drug. Do treat anaemia. Go for Tsh 2D echo Ecg

B blocker ???? Keep control of BP and diabetes

HYPOTHYROIDISM WITH UNCONTROL DM & ANEMIA Rx Anemia With Oral Ascorbate Iron ( if hb less than 8 then use Iv iron ) Wait for report.... Check KFT & DKA DKA has Symptom of DOE

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