Uncontrolled diabetes

Female patient of age 58 Chief Complaints Uncontrolled diabetes History Patient is Diabetic taking insulin since 5 year BUT since one year she had stopped taking insulin as her diabetic is in control by oral medication but since 10 days her glucose levels increase On going medication voglibose .3 mg one od morning plus glycomet gp 2 one bd after meal Vitals Bp:120/70 Pulse:80 Sleep normal App:normal Motion normal Weight:80 Investigations Rbs:300 today(03/01/2020) Hb1ac 9 No other morbidity Diagnosis Dm2 Management My concern is it good to start insulin therepy again Or some changes in oral medication can help her. As she denied to restart insulin

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Thank you for tagging me Dr Shoaib Aslam. This is a case of obese, Uncontrolled Type2DM with secondary OAD failure. In this case best option is to start biphasic premixed human insulin or analogues along with existing OAD's as her blood sugars as well as HbA1c is also high Start with 25 units in the morning before breakfast and 15 units in the night before dinner. Adjust the dose according to the blood sugars. If you start human premixed insulin, you have to give it half an hour before breakfast and dinner. If she can afford to use novel rapid acting analogue insulin, it has to taken 5 minutes before breakfast and dinner. Glycomet Gp2 tablet has to be taken half an hour breakfast and dinner. Give counselling regarding LSM and TLC.

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You can add dapagliflozin if she doesn't have UTI otherwise add vildagliptin 50mg 1bd Keep followup and monitoring if not controlled than yes can be shifted on insulin

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Uncontrolled diabetes Needs physical activity or exercise for exhausted heavyweight of middle aged patients, and also fully restricted the diabetic dietary supplements. Please follow the prescription of Sir@Dr. Shivraj Agarwal . I think much better and recovery soon.

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Uncontrolled type2 diabetes Lifestyle modification Diet control,start Tab linagliptin 5 mg once daily Follow up pt after 15 days do BSF ,PP If not controlled start insulin

Add once daily Long acting insulin ( Glargine/ Degludec) at bed time. And Give total dose of Glimepiride in morning before breakfast. Make Metformin 1gm BD if kidney function is within normal limits. Stop Voglibose and add Sitagliptin 100g once daily before lunch.

Gudmaar booti.. Shilajeet.. Naagbhasam.. Giloy satva. Tamra bhadam Vangabhasam Chirayta jamun ki guthali.., haldi..indrajau.., in sabko equal lekar..churna bna ke.. 1ts bd with normal water.. Sath me.. Metformin+glicazide+viglibose tab bd.subah sham before meal. SGLTR TAB ..OD afternoon before meal.. 100% Result..many patient cure by this

Now she maintains diet ,and tab -diabalife 1bd for 3 months, continued insulin

Acid phos Q +Syzigium jam Q mix in equal quantity 20drops tds with aqua Uranium nit 30. 4 tds

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