Type 2 Diabetes Mellitus, probably having hypoglycemia

A 45 year old male driver by profession Chief Complaints His main complaints for past 4 to 5 days are loose motions, vertigo, ghabrahat, sweating somtimes, he says his FBS is around 170, but his PPBS when he check once or twice was 80 and 100 Vitals RBS - 108 BP - 135/85 PR - 97 Investigations His HBA1c has decreased from 13 in Oct 2020 and now as per yesterday report - HBA1C - 7.4 TG's , Non HDL raised Mild elevation in transaminases Management He is currently on - Inj Huminsulin 30/70(14 units)20min before bfast Inj Lantus 16 units SC at 10pm Tab Pioz 15mg OD Tab Zucapride 10/500 Morning Tab Glycomet SR 500 after dinner Had advised him for stemetil MD and redotil for 2 days but no relief. Kindly give your valubale feedback on this case which I am atrributing to hypoglycemia, so advise for downtitration of regimen

(Edited)

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45 YEARS OLD PATIENT SEEMS TO HAVE D M EITHER HE IS NOT TAKING HIS ANTIDIABETC MEDICINES REGULARLY OR HIS DOSE FOR HIS DIABETIC CONTROL IS NOT SATISFACTORY HE HAD PREVIOUS HBAIC AS 13.B VERY HIGH DROPPING SUDDENLY TO7.4 NOW HE IS IN A STATE OF HYPOGYCEAMIA CAUSING SWEATING VERTIGO LOOSE MOTIONS HE HAS TO BE ADEQUETLY TREATED FOR D M

Its been almost more than 2 months of medications
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NEED'S.. ELECTROLYTES.. OFLOXACIN + ORNIDAZOLE.. PROBIOTICS.. ANTIDIABETIC MANAGEMENT AS IT'S..

Tnx Dr Millind Raut..
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Yes doses of morning insulin is high should be around 8 to 10 units Lantus 10units is more than sufficient Tab pioz 15 at dinner or better omit it Add vildagliptin 50mg

Thanx dr Vipin Bihari Jain
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What about his urine ketone sugar? Reduce insulin 30/70 Tb glycomet 1 gm in place of SR And review after 1 week

Diabetic management is what you suggest is fine Oral fluids For loose motion Add cap vibact ds Tab oflox oz Tab emidoxyn Cap RBSON -d

Decrease dose of huminsuline by 4 units.Adjust dose of lantus to control fasting glucose.Also dose of metformin can be increased.

Check electrolyte s O2 bd Delponorm bd CtAll diabetic treatment

For now, I have advised him to reduce the morning insulin to 10 units, lantus to 14 units Tab Vildamac M 50/500 BD

Better to make pioz 7.5 mg

Stop insulin and other OHAs Continue only Vildamac M BD Check FBS, PLBS after one week

Valuable opinion
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