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Suggest Treatment For Diabetes Mellitus Type II
Posted on
Mon, 30 Mar 2015
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Mon, 30 Mar 2015
Answered on
Tue, 21 Apr 2015
Last reviewed on
Question : For endocrine management of a patient diagnosed with diabetes mellitus. According to PMH and current lab values, vital signs, urine culture, and EF of 35%, what would be the correct assessment and what else would we need to know?
Brief Answer:
A plan
Detailed Answer:
Good day,
Noted your concerns.
Noted that the serum creatinine is elevated and EF us reduced to 35%. BP is on the higher side too.
Apart from Metoprolol, she may need a diuretic as additional antihypertensive to bring down the BP.
From diabetes point of view, with an Hba1c of 9% and reduced kidney and cardiac functions, I will not recommend any oral medications. Insulin is the best option for her.
She need a comprehensive assessment looking for diabetes related eye and feet problems as well. Cholesterol and BP should be adequately controlled.
Encourage simple exercise and smoking cessation.
A plan
Detailed Answer:
Good day,
Noted your concerns.
Noted that the serum creatinine is elevated and EF us reduced to 35%. BP is on the higher side too.
Apart from Metoprolol, she may need a diuretic as additional antihypertensive to bring down the BP.
From diabetes point of view, with an Hba1c of 9% and reduced kidney and cardiac functions, I will not recommend any oral medications. Insulin is the best option for her.
She need a comprehensive assessment looking for diabetes related eye and feet problems as well. Cholesterol and BP should be adequately controlled.
Encourage simple exercise and smoking cessation.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Besides being diagnosed with DM Type II would her diagnosis change to include DM, HTN stage II, and any other diagnosis?
For medications, should I keep her on the metoprolol XL 100 mg daily and Lipitor 40 mg daily? Also, could Metformin be considered along with a sliding scale insulin or do you have better recommendations?
Any more thoughts?
For medications, should I keep her on the metoprolol XL 100 mg daily and Lipitor 40 mg daily? Also, could Metformin be considered along with a sliding scale insulin or do you have better recommendations?
Any more thoughts?
Brief Answer:
No Metformin now
Detailed Answer:
Yes Metoprolol XL and Lipitor must be continued. However having a creatinine of 1.6 and with reduced Ejection fraction of heart , I will not recommend Metformin.
Insulin is the drug of choice. HER diagnosis would include Type 2 DM, Hypertension, CRF(increased creatinine ), and LV dysfunction (in view of Low EF )
No Metformin now
Detailed Answer:
Yes Metoprolol XL and Lipitor must be continued. However having a creatinine of 1.6 and with reduced Ejection fraction of heart , I will not recommend Metformin.
Insulin is the drug of choice. HER diagnosis would include Type 2 DM, Hypertension, CRF(increased creatinine ), and LV dysfunction (in view of Low EF )
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you!
Would you recommended a sliding scale of insulin and would it be regular Humalog?
Would she need a rapid acting insulin, Regular or short-acting insulin, intermediate acting, or long acting? One or a combination of two? If so, what would be a good recommendation for the sliding scale?
Would you recommended a sliding scale of insulin and would it be regular Humalog?
Would she need a rapid acting insulin, Regular or short-acting insulin, intermediate acting, or long acting? One or a combination of two? If so, what would be a good recommendation for the sliding scale?
Brief Answer:
Insulin regimen
Detailed Answer:
Sorry for the delay. ( due to the time zone difference)
No, sliding scale is not preferred.
I would rather give her a basal long acting insulin at night ( either Lantus or Levemir) and small doses of Humalog before each meals.
Other option would be to give a premixed insulin twice daily , before breakfast and before dinner ( MIXTARD or NOVOMIX or HUMALOG MIX).
Unfortunately i can not precribe a dose onlie as it is illegal. Besides, i have not seen the patient. You may have to get in touch with your PCP
Once she is on an insulin regimen, she need daily blood glucose monitoring with a glucometer atleast 3-4 times a day ( fasting, before meal and at bedtime). Keep fasting at around 120-130 and around 180 at other times. This is a safe target at the time being considering the kidney and heart issues. We may later intensify the insulin regimen for a more tighter control if required.
Insulin regimen
Detailed Answer:
Sorry for the delay. ( due to the time zone difference)
No, sliding scale is not preferred.
I would rather give her a basal long acting insulin at night ( either Lantus or Levemir) and small doses of Humalog before each meals.
Other option would be to give a premixed insulin twice daily , before breakfast and before dinner ( MIXTARD or NOVOMIX or HUMALOG MIX).
Unfortunately i can not precribe a dose onlie as it is illegal. Besides, i have not seen the patient. You may have to get in touch with your PCP
Once she is on an insulin regimen, she need daily blood glucose monitoring with a glucometer atleast 3-4 times a day ( fasting, before meal and at bedtime). Keep fasting at around 120-130 and around 180 at other times. This is a safe target at the time being considering the kidney and heart issues. We may later intensify the insulin regimen for a more tighter control if required.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you! I am going to close this discussion and submit my review. Very helpful!!
oppps, guess I cant until you reply. Thank you again!
oppps, guess I cant until you reply. Thank you again!
Brief Answer:
Thank you
Detailed Answer:
Thank you for the reply. I hope her blood glucose will be well controlled soon.
Best regards
Binu
Thank you
Detailed Answer:
Thank you for the reply. I hope her blood glucose will be well controlled soon.
Best regards
Binu
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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