Concluded Case

Uncontrlled type 2 diabetes

58 yr/F c/o anxiety, fever since 2 days due to fasting.. she is k/c/o DM with htn since 10 yr... N on treatment of metformin SR 1000 mg BD Dynagliptin 20 mg HS Diet control 1800 kcal Telma-ct 40/12.5 at morning Clinidipine 5mg HS Current inv..fbs 300 Ppbs 403 HbA1c awaited report B.p. 130 /88 Hr 105/ min Weight 60 kg ht 5.3..BMI -23 Pt .deny for switch to insulin treatment How to manage.?Kindly suggest

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How are her renal functions. Pl go for eGFR.if her eGER is more than 50.to 60.u can sglt2 inhibitors. Empa / cana/ rema gliflozine u can add gliclazide 80 mg bd .tab voglibose 2mg bid.pl repeat blood sugars after 10ndays

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How are her renal functions. Pl go for eGFR.if her eGER is more than 50.to 60.u can sglt2 inhibitors. Empa / cana/ rema gliflozine u can add gliclazide 80 mg bd .tab voglibose 2mg bid.pl repeat blood sugars after 10ndays

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As FBS is high she needs long acting OHA Start Glimiperide + metformin (2+1000) bd Dynaglipt 20 od Glucobay 50 mg TDS Pioglitazone 15 mg hs Repeat test after 3 -5 days.

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If fever due to any infection ,it transiently elevate sugar level , glimepride 2 mg bd and metformin 1500 mg three divided doses ,and periodical cbg analysis ,if further elevated sugar ,should start short acting insulin According to blood sugar thrice daily till fever resolve . Ct 12.5mg can be withhold if fever intesity high

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