Uncontrolled T2DM even on premix analogue Ryzodeg

So this female was currently on following medications, but still her FBS is 175 and RBS is 280 Management She is on - Ryzodeg 26 units morning, 22 units bedtime, Gluconorm g4 forte morning Glycomet Gp2 after dinner Pioz 15mg OD after lunch Voglibose 0.3 TDS Kindly guide for appropriate management for her blood sugars? Can we resort to adding Repaglinide/Voglibose 0.5/0.2 BD with breakfast and lunch? Add 2 units of insulin both morning and night? How about switch to mixtard insulin 30/70, as such high consumption of Ryzodeg is putting a big dent in her pocket? Give your valuable opinion Check attached case below

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This is a c/o insulin dependent Type 2 dm progressed to type 1 as there is no beta cells for internal insulin I will place her on plain insulin ie insulin R 15units tds Inj mixtard 50:50 20units bd With monitoring of bsl every 6hrly till desired effects Amongst OHA My choice is very evdent Glimiperide 1mg+vildagliptin 50mg+metformin 500mg 1bd Sos i will consider dapagliflozin

FEMALE PATIENT TYPE2 DM FBS 175 AND RBS 280 SHE IS ON BOTH ON OHA AND INSULIN MOST IMPORTANT THING IS WHAT IS HER HBAIC THAT IS THE MODALITY WHICH WILL SHOW US HER LAST 3 MONTHS BLOOD SUGAR AND BETTER IDEA OF CONTROLL OF D M AND FURTHER MANAGEMENT OF DBM

The OHAs are all crossing daily maximum dose. Please refrain from such high doses else it’ll mess her Renal function completely. Start Tab. Glycomet GP2 BBF- BD Tab. Istavel 50mg BBF- BD Tab. Volibo 0.3 AL Tab. Jardiance/Gibtulio 25mg BBF Bring down Ryzodeg to 14units at 10pm The more OHAs/insulin you give, the more her requirement will keep increasing. Don’t worry..she’s a case of insulin resistance. Repeat her FBS,PLBS,RFT after 15days. Her A1c is not sky high to be on so many meds. Put her on a diet.. 8am BF 11am snack/fruit 1pm lunch 4pm tea/snack 8pm dinner Increase hydration to 2lts/day Do her ANA by IF from SRL/Metropolis

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A case of uncontrolled Type2DM Investigate HBA1c,KFT,LFT,Lipid profile urine Ketone Stop Tab Glimipride Continue Tab Metfotmin2gm S/CRyzodeg 28 unit morning 24unit bedtime TabGlyxambi 25 /5 1tab after BF Blood sugar monitoring F,pp,bd

I ncrease dose by# 2 unit Pioglitazone tds Add vidagliptin Diabetic diet Do hb1ac

We can add inj insulin R qid

Simplest put him on lantus in night controll fbs and titrate oha

Stop pioglitazone cause it has many side effects for old female ladies .....add vildagliptin and increase the insulin by 4 units both in the morning and night will give better control

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