#MedicalCase
How to manage a person with a blood sugar level of more than 400? (Diabetology)
Albana Greca., MD, MMEDSC
Medical Case Details:
Hello, in a diabetic patient, the blood sugar level is more than 400 for one week. Already, there is a history of diabetic nephropathy and hospitalized one month ago. The patient is on Insulin Novomix and Aspart, along with antihypertensive medicine. I advised adding Insulin dosage and suggested a urine test. What can I add more? I am thinking of adding Glibenclamide. Would it be appropriate? If I decide to put on intravenous therapy, what is the best choice? Thank you in advance. Dr.AlbanaDiscussions
Dr. Gupta Abhinav
Diabetologist
Go for urine ketones...
WHATS HBA1C like.
Novomix Regular or 30/70..
Is patient obese...
Diabetologist
Go for urine ketones...
WHATS HBA1C like.
Novomix Regular or 30/70..
Is patient obese...
▲ 1
15.Apr, 06:33pm
Dr. Zulfiqar Ahmed
Diabetologist
Hi. Good day. Thanks for asking. I would prefer to go for lantus at night with short acting insulin three times daily after ruling out hyperosmolar situation. Also I would like to stress on compliance of medications plus diet. Thanks.
Diabetologist
Hi. Good day. Thanks for asking. I would prefer to go for lantus at night with short acting insulin three times daily after ruling out hyperosmolar situation. Also I would like to stress on compliance of medications plus diet. Thanks.
▲ 1
15.Apr, 06:39pm
Dr. Nadeem Abootty
Diabetologist
Hi
Rule out Diabetic ketoacidosis/ HHS.
If not,and electrolytes are normal adjust insulin in basal bolus regimen with novorapid TID and insulin glargine at bedtime.if symptomatic admit and Start on IV insulin infusion and adjust accordingly.
Don't start on glibeclamide as patient is known nephropathy patient,Boz may induce hypoglycemia..
If required can add on DPP4 inhibitors or SGLT2 estimating eGFR of the patient.
please verify the insulin site, method,storage and insist on proper meal timing,excersise.
Diabetologist
Hi
Rule out Diabetic ketoacidosis/ HHS.
If not,and electrolytes are normal adjust insulin in basal bolus regimen with novorapid TID and insulin glargine at bedtime.if symptomatic admit and Start on IV insulin infusion and adjust accordingly.
Don't start on glibeclamide as patient is known nephropathy patient,Boz may induce hypoglycemia..
If required can add on DPP4 inhibitors or SGLT2 estimating eGFR of the patient.
please verify the insulin site, method,storage and insist on proper meal timing,excersise.
▲ 1
15.Apr, 06:51pm
Dr. Qazi Mujahid Ali
Diabetologist
Welcome dear, all our colleagues suggested several options and very valid and practical.
In short as I suggest start basal insulin at night and Rapid acting before each meal in addition to sitagliptin 50 mg twice daily, SGLT2 inhibitor may also be added.
we have another choice start sitagliptin 50 mg twice and SGLT2 INHIBITOR 10 mg after breakfast. and adjust the dosage of current regime of insulin.
whatever the choice adopted, diet is playing key role the patient must reduce his fatty content in his diet and obviously must stop all sugary things. It Will be preferable if short meals are taken.
If patient can afford physical activity what so ever, is also important.
It would have been better if we had some knowledge about age, weight, height And HbA1c.
SMBG is very important to adjust the dose of insulin.
Further more education to inject insulin is most important it is better if patient or his attendant who is dealing with insulin should be educated.
Diabetologist
Welcome dear, all our colleagues suggested several options and very valid and practical.
In short as I suggest start basal insulin at night and Rapid acting before each meal in addition to sitagliptin 50 mg twice daily, SGLT2 inhibitor may also be added.
we have another choice start sitagliptin 50 mg twice and SGLT2 INHIBITOR 10 mg after breakfast. and adjust the dosage of current regime of insulin.
whatever the choice adopted, diet is playing key role the patient must reduce his fatty content in his diet and obviously must stop all sugary things. It Will be preferable if short meals are taken.
If patient can afford physical activity what so ever, is also important.
It would have been better if we had some knowledge about age, weight, height And HbA1c.
SMBG is very important to adjust the dose of insulin.
Further more education to inject insulin is most important it is better if patient or his attendant who is dealing with insulin should be educated.
▲ 1
16.Apr, 02:40am
Dr. Albana Greca
General Practitioner
Hello to all,
Thanks alot about your valuable input.
Age: 70 years old
Weight: 103 kg
Height: 178 cm
HbA1C: 11%
Already sent urine sample for analysis and ketones, otherwise in good condition, no other complains.
But I think he is misusing his insulin, will be discussing this afternoon with him after checking urine result.
Thank you again
General Practitioner
Hello to all,
Thanks alot about your valuable input.
Age: 70 years old
Weight: 103 kg
Height: 178 cm
HbA1C: 11%
Already sent urine sample for analysis and ketones, otherwise in good condition, no other complains.
But I think he is misusing his insulin, will be discussing this afternoon with him after checking urine result.
Thank you again
16.Apr, 02:19pm
Dr. Albana Greca
General Practitioner
Patient is having ketones in urine, and protein too, and glucosuria.
The only problem is being thirsty all the time.
Should I put on iv treatment. I already asked to get NaCl infusion done just for today.
What else? His fasting Blood sugar is still 400 today.
Thank you.
General Practitioner
Patient is having ketones in urine, and protein too, and glucosuria.
The only problem is being thirsty all the time.
Should I put on iv treatment. I already asked to get NaCl infusion done just for today.
What else? His fasting Blood sugar is still 400 today.
Thank you.
17.Apr, 03:51pm
Dr. Zulfiqar Ahmed
Diabetologist
U should check his blood ketones and do VBG to see bicarbonates to rule out keto acidosis. If there’s keto acidosis he should be admitted and treated as per protocol of keto acidosis. Also to rule out hyper osmolar condition. Otherwise he should be treated on basal bolus regime. Thanks
Diabetologist
U should check his blood ketones and do VBG to see bicarbonates to rule out keto acidosis. If there’s keto acidosis he should be admitted and treated as per protocol of keto acidosis. Also to rule out hyper osmolar condition. Otherwise he should be treated on basal bolus regime. Thanks
▲ 1
17.Apr, 07:14pm
Dr. Nadeem Abootty
Diabetologist
Please see for ABG, electrolytes and creatinine. rule out any hidden infections..
if acidosis persists ,admit and go for IV fluids+ IV insulin infusion.monitor potassium and correction accordingly.
once stablised and blood sugars under control can switch over to basal bolus regimen.
Diabetologist
Please see for ABG, electrolytes and creatinine. rule out any hidden infections..
if acidosis persists ,admit and go for IV fluids+ IV insulin infusion.monitor potassium and correction accordingly.
once stablised and blood sugars under control can switch over to basal bolus regimen.
▲ 1
17.Apr, 11:21pm
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