Tough case of T2DM

A very typical tough case of T2DM T2DM+ HTN+ BPH +HYPERURICEMIA 63 yr old male retired person He has been complaining of pain in right shoulder for last few weeks and his sugars are fluctuating and his current FBS in last two days was in range of 200 and PPBS was 165 mg/dl HBA1C - 6.9 Uric Acid - 8.5 BP - 140/90 After seeing uric acid so high and BP deranged, I have put him now on febuxostat 40mg BD along with Tramadol + PCM combination BD, and changed telmisartan+ chlorthiadone to telmisartan + CCB+ chlorthiadone. He is currently on these medications for T2DM- Glimipiride 3mg + Metformin 1000mg BD Empagliflozin 25/Linagliptin 5 OD My concerns are specially for his diabetes - 1) Can adding HCQ 400mg a bedtime help to control his blood sugars? I have read a lot about HCQ benefits in patients of T2DM. 2) What all changes can be instituted in his diabetic medicines if needed? He is already on 6mg of Glimipiride in a day, his HBA1C is only 7, but his FBS is deranged. 3) Can HCQ along with Tamsulosin/Dutasteride be given at bedtime? Note - One mistake that I have done is to avoid HCTZ and Chlorthiadone for hypertension in hyperuricemics.

(Edited)

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1) This patients HbA1c is well over control HbA1c is better target of diabetes control than individual blood sugar value, because it represents average of last three months blood sugar value He is on very high dose of Glimepiride, it is notorious for causing hypoglycemia, therefore I would be apprehensive of further increasing diabetes medication because 1) HbA1c is in target range 2) Danger of hypoglycemia Durasteride and Tamsulosin can be given at bed time - it has no relation with diabetes Febuxostat to be continued Shoulder pain to be evaluated separately - ? Frozen shoulder

First of all you rule out why BP increase, do CBC & ESR, lipid profile, Serum Electrolyte, ECG, LFT, RFT, CXR P/A, BCZ HBA1C IS CONTROL, SOME DRUGS INDUCES BLOOD SUGAR LEVEL, FOR BPH GIVE TAB. URIMAX D TDS, BP. Give Tab Amlodec 5 mg, OD, & For Sugar Give tab. Janumet BbF & Zoryl M2 Before Dinner, Do C-Peptide.

Thanx@Dr. Dinesh Gupta Sir Ji
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Better to start basal insulin .....ask him to check before breakfast,afterbreakfast, before lunch ,afterlunch before dinner and after dinner mid night sugar should be checked to whether is getting hypoglycemia in midnight we need to look into that

ADA HAS NOT RECOMMENDED TILL YET, POSSIBLE FROZEN SHOULDER, TAKE HELP OF ORTHOPEDICS, PHYSIOTHERAPIST, YOU CAN ADD PREGABALIN/ GABA/NTP/ DOLUXTIN THEY ARE RECOMMENDED, BLOOD SUGAR IS WELL CONTROLLED, ADD B12, ZINC, CHROMIUM

Diabetic diet Walking 40 minutes Hcqs add on drug to control hyperglycemia with fixed doses from2014 worth trying do ECG

This is a case where you can use bedtime IGlar or IDeg rather than overburdening with OADs. Start with 10iu at 10pm.

Off cours 3 is continue

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