Uncontrolled T2DM

A 54 year old male presented to OPD with increased frequency of urination and difficulty in vision Weight 72kgs History He recently had a RTA like 1 week back where he sustained L/W over right hand and was given 10 stitches for the same Investigations His investigations are quite deranged have a look please If not clear, crux of investigation is - HBA1c - 12.6 S.Cr - 1.88 Uric acid - 7.78 Management I have started him on basal bolus regimen Glargine insulin 12 units at 10pm, Regular Insulin 4 units 25 mins before bfast, lunch and dinner, Tab Furic 40 OD morning, His FBS is around 220 and PPBS after lunch qas 538, please guide for insulin titration? I am planning to increase glargine by 4 units and each regular insulin dose by 2 units Today upon follow up I am planning to add him Metformin 500 mg BD Give your valuable opinion on this case Insulin dose calculated as = 0.3 to 0.5 units/kgbw

(Edited)

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Yes uncontrolled diabetic The regime you followed wait for results for couple of days it should come under control If not controlled that means insulin resistance Hence i will prefer to add dapagliflozin+metformin Also stepup doses of fabuoxate to 80mg

Thanx dr Kute Ankush
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? UNCONTROLLED DIABETES WITH .. DIFFICULTY IN VISION .. HBA1C .. INCREASED.. NEED'S.. STRICT GLYCEMIC CONTROL WITH ANTIDIABETIC MANAGEMENT WITH EXPERTS OPINION.. INSULIN .. OHA .. ENDOCRINOLOGIST OPINION.. EYE EXAMINATION WITH EXPERTS OPINION FOR NECESSARY .. MANAGEMENT..

Tnx Dr Shivraj Agarwal sir
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I agree with basal bolus regimen, dose escalation as per blood sugar level. Glargine insulin can be increased because both fasting and post lunch blood sugars are high Febuxostat need to be started for raised uric acid Consider starting Bethanechol 25 mg one tablet three times a day in view of raised creatinine Addition of Metformin is acceptable because Metformin can be given if eGFR is more than 30. I think you are on right tract, your patient by now would have felt great symptomatic improvement

Valuable opinion
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Uncontrollable dm Diabetic diet Diabetic specialist Fundoscopy Short acting insulin tds Add gm2 bd

Long acting bbf bd Short acting bbf bl Point 5 to1 mg per kg in3 divided doses
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Uncontrolled DM Dose of Glargine 18 unit at bed time Regular insulin6-6-6 Continue Tab Metformin 500 Bd Tab Furic40 od inmorning Eye examination do urine ketone microalbumin in urine Blood sugar monitoring F ,pp bd dose should be titrated according to BS level

Valuable opinion
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Yes, you can start Metformin but monitoring the Creatinine level is essential.

This is uncontrolled DM2 with DKD with ? retinopathy Fundus Urine ACR Vit D3 S. Calcium Please advise these investigations. First correct FBS by up titrating Basal dose. Target should be 80-130. You can add empagliflozin + Linagliptin. If Urine shows microalbuminuria, start low dose ACE inhibitors/ARB

Strict control of diabetes Consult eye specialist Consult Endocrinologist

chronic uncontrolled diabetes Rx start vasant kusumakar ras 1 tab BD.

It's a case of uncontrolled DM with diabetic?retinopathy and ? Nephropathy.....need to evaluate by funduscopy and USG abd+pelvis...urine analysis..... First of all admit the pt and take him on bsl monitoring with 5 times a day with s/c short acting insulin for urgent controlling of high sugar levels....after controlling sugars and improving renal function...maintaning proper hydration and electrolyte balance u can decide for OHA and long acting insulin...

I agree
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