Dr. Suhas Erande: A case of T2DM uncontrolled on multiple OADs
CASE OVERVIEW
A case of uncontrolled diabetes on oral antidiabetic drugs (OADs) was encountered by Dr. Suhas Erande when a 60 years old female patient visited him with a history of long-standing diabetes (for over 10 years). Her weight was 65 kgs with a BMI of 26 kg/m2. She had a medical history of hypertension and diabetic peripheral neuropathy. She was on Glimepiride + Metformin 2/500 BID, Teneligliptin 20 mg OD, Telmisartan 40 mg OD, Aspirin + Atorvastatin 150/10 HS then.
DIAGNOSIS
The patient’s HbA1c was 9.9%, with post-prandial glucose and fasting blood glucose levels of 300 mg/dl and 189 mg/dl, respectively. Her blood pressure was 140/90 mmHg, creatinine was 0.9 mg%, and eGFR was 80 mL/min. Her complaints were – frequent urination, exhaustion, and burning feet.
TREATMENT
Before initiating an insulin regime for the patient, she was counseled on the need for insulin for better control of sugar and other symptoms. Since her breakfast was the most substantial meal of the day and her post-breakfast sugar levels were the highest, injection were included prior to breakfast. Her medication regime was planned as follows – IDegAsp BBF, Glimepiride and Metformin continued at lunch & dinner. Pregabalin 75 mg HS was initiated for neuropathic symptoms and 12 U (0.2 U/Kg BW) was initiated for better sugar control. IDegAsp 12 U OD (FlexTouch pen) was the initial dose which was gradually up titrated and intensified to BD. She was advised for SMBG including FBS every 3 days along with post-breakfast, post-lunch & post-dinner sugars. As advised, she was regularly walking 4 km. Every week telephonic support and follow-ups were conducted.
RESULTS
Gradual weekly up-titration of the dosage with structured SMBG resulted in smooth round-the-clock sugar control steering clear of hypos. Patient’s HbA1c was 7.8% after 3 months of treatment; her frequency of urination vanished within 2 weeks. Her neuropathy symptoms gradually disappeared in 3 months. Her quality of life has improved & she has not had low sugars anytime.
