Uncontrolled PPBS

I have a diabetic patient who is under treatment, his main concern is PPBS which is 360/288/290, and his FBS is 134/144 and so on How to tackle his PPBS? History He is a retired police personnel so very much into walking, daily almost an hour and completely following LSM Management He is currently on Janumet 50/500 twice daily, Pioz-M 15/500 OD, Tab Voglix R 0.3/0.5 with lunch and Inj Lantus 8 units at 10 pm daily.

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It seems he is having advanced diabetes His fasting blood sugar is reasonable/ sightly high, post meal sugar is very high, therefore dose of Glargine insulin can not be increased Therefore he is having advanced diabetes and his own insulin secretion in response to meal is significantly reduced Advice Add short acting insulin analogue with each meal Example Inj. Glulisine (Apidra) 8 units with each meal That will take care of postprandial blood sugar rise

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My Revised treatment: The prime idea is to reduce pill burden and to improve patient compliance and convenience. 1. Inj Lantus 10 units at bedtime and there after increase by 2 units per week till his FBS reaches 100 mg/dl. 2. Gemer P2 (glimepiride 2 mg + Pioglitazone 15mg+ Metformin 500mg) one tablet 30 min before breakfast. 3. Oxra met 10/1000 ( Dapagliflozin + Metformin 1000mg) at dinner.. Monitor blood sugar periodically and adjust the doses. Finally, Explain the need to take small feeds at frequent intervals, not large meals, even if it is the same quantity over 24 hours.

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NEED'S.. * DIABETIC DIET PLAN.. * LONG ACTING INSULIN INFECTION..DEGLUDEC .. * ENDOCRINOLOGIST OPINION..

Tnx Dr Nikunj Satasiya
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What is the condition of prostate in him (as he is a retired man) ? SGLT2i should be cautiously given to aged men. Duration of T2DM is not mentioned. Long standing T2DM usually have secondary SUF due to pancreatic beta cells apoptosis. If PPBS remains high then either administer Voglibose just before each meal or bolus insulin analogue before each meal.

Consider basal bolus regimen. Add novomix in morning. Or inj ryzodeg with major meals.

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RETIRED POLICE OFFICER AGE NOT MENTIONED HAS KIND OF UNCONTROLLED D M PPBS VARIES FROM 360 288 290 FBS 134 144 ON.OHA HBAIC NOR MENTIINED NEEDS CONSULTATION OF DIABETOLIOGIST OPHTGALMIC EXAMINATION DIET CONTROL MAY NEED INSULIN

Usually I have experienced that if pt is explained about the dose of Insulin ,when to increase and when to decrease the dose of Insulin, pt gets better outcomes. Pt should b admitted in hospital and suitable Insulin should b started.

In homoeopathy 3 great medicine good work for control the diabetes Sygygium jembolenum q Rhus arometica q Cephalemdra q Mix in same bottel nd give 15 drops tds for 1 month Give marvelous result

Very well explained by Dr. Jayesj

Ppbs is high Hb1ac Add inj glushinine before lunch Diabetic diet Excercise Every day check fasting pp with glucometer Othermedicine continue

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