How to manage Diabetes in OPD ? Discussion of three cases requiring insulin

Dr. Om J Lakhani discusses three clinical cases of diabetes in detail in outpatient each requiring insulin
00:27 🩺 Managing Diabetes Case 1: Surgery Preparation
Patient profile: 51-year-old male with type 2 diabetes, BPH, obesity, and hypertension.
Clinical profile: Elevated fasting sugar, high HbA1c, obesity, high blood pressure, and other comorbidities.
Treatment approach: Considering insulin due to poor glycemic control and upcoming surgery, preferring basal insulin over other formulations, adjusting insulin dose based on HbA1c guidelines.
02:42 🩺 Managing Diabetes Case 1: Treatment Decision
Decision-making process: Evaluating the need for insulin based on HbA1c and medication regimen.
Insulin selection: Opting for basal insulin over premix or co-formulation considering patient's glucose levels.
Insulin dosing: Initiating basal insulin using an individualized formula, considering patient's fasting plasma glucose.
Adjunctive therapy: Adjusting oral anti-diabetic drugs and considering GLP-1 receptor agonist based on patient's profile and cost considerations.
11:28 🩺 Managing Diabetes Case 2: Decompensated Liver Disease
Patient profile: 64-year-old male with chronic liver disease and poorly controlled diabetes.
Clinical presentation: Elevated fasting sugar, high HbA1c, complications of chronic liver disease.
Treatment strategy: Transitioning from premix insulin to basal insulin, adjusting insulin dose using a standardized formula, optimizing oral anti-diabetic drugs based on safety profile in liver disease.
18:15 🩺 Managing Diabetes Case 3: Type 1 Diabetes Diagnosis
Patient profile: 26-year-old male presenting with severe hypoglycemia and ketosis, diagnosed with type 1 diabetes.
Initial management: Hospitalization, IV fluids, insulin infusion to manage diabetic ketoacidosis.
Transition to outpatient care: Switching to basal-bolus insulin regimen, individualizing insulin dose based on mixed meal stimulation test, ongoing monitoring and adjustment of insulin therapy.
27:16 📊 Understanding Patient's Diabetes Type
C-peptide levels and post-meal C-peptide less than six indicate insulin requirement.
A proprietary scoring system suggests the patient is unlikely to have type one diabetes, but follow-up is necessary.
The patient presents with good endogenous insulin production but experienced ketosis, raising uncertainty about the diabetes type.
29:09 💉 Transitioning to Insulin Therapy and Medication Management
Gradually replaced short-acting insulin with basal insulin and introduced oral agents.
Caution against prescribing SGLT2 inhibitors due to the risk of ketosis.
Adjustment of medications based on glycemic control and patient response.
30:06 🔄 Patient's Follow-Up and Management Challenges
Emphasizes the importance of continuous monitoring and reporting to prevent complications.
Patient's recurrence of ketosis underscores the need for vigilant monitoring and timely intervention.
Uncertainty persists regarding the patient's diabetes type, leaning towards a severe form of type two with impaired beta cell function.
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[@millennialspharmacology2627]

Thank you for case discussion at OPD..very informative sir Please keep posting more opd based case discussion 🙏😊

[@dharmintrivedi479]

Thank you sir for this awesome case discussion. It is my earnest request to you to upload a lecture on pathogenesis and treatment of type 1 diabetes mellitus. Thank you once again.

[@Snigdhwala]

Sir take class 🙏🏻🙏🏻 On type 1 DM How to diagnosed TYPE 1 DM nd Management

[@EndocrinologyIndia]

Sure

[@Snigdhwala]

Sir any update on Type 1 DM class??

[@umasudheer9291]

Nice presentation but that double liner pen is not good while seeing not visible properly.

[@EndocrinologyIndia]

Noted

[@Vwm93]

Sir, I am a Pharmacist cum diabetes educator.A patient taking premix insulin 25/75,2dose before breakfast and before dinner . I changed the food taking pattern.In the morning after taking insulin the patient eat lunch time food(rice,salad,dal,fish etc,and during the lunch time the patient taking breakfast time''s food(like roti,daliya etc).The patient is good ppg control and no hypoglycemia issue. Can apply this technique to all premix insulin taking patient.Thank you your videos are very helpful for me.

[@EndocrinologyIndia]

Of course

[@user-hd9gu6iw6l]

Thank you for the case discussion. Expect that it will be continued. Double line letters are not eye - friendly. Do you prefer injectable form or other forms of Vitamin B12 for DSPN and what is the dose?

[@EndocrinologyIndia]

Noted

[@EndocrinologyIndia]

No we don’t prefer injectable b12 unless specific evidence of malabsorption

[@drsanjaykumar3448]

Analytic

[@EndocrinologyIndia]

🎯 Key Takeaways for quick navigation: 00:27 *🩺 Managing Diabetes Case 1: Surgery Preparation* - Patient profile: 51-year-old male with type 2 diabetes, BPH, obesity, and hypertension. - Clinical profile: Elevated fasting sugar, high HbA1c, obesity, high blood pressure, and other comorbidities. - Treatment approach: Considering insulin due to poor glycemic control and upcoming surgery, preferring basal insulin over other formulations, adjusting insulin dose based on HbA1c guidelines. 02:42 *🩺 Managing Diabetes Case 1: Treatment Decision* - Decision-making process: Evaluating the need for insulin based on HbA1c and medication regimen. - Insulin selection: Opting for basal insulin over premix or co-formulation considering patient's glucose levels. - Insulin dosing: Initiating basal insulin using an individualized formula, considering patient's fasting plasma glucose. - Adjunctive therapy: Adjusting oral anti-diabetic drugs and considering GLP-1 receptor agonist based on patient's profile and cost considerations. 11:28 *🩺 Managing Diabetes Case 2: Decompensated Liver Disease* - Patient profile: 64-year-old male with chronic liver disease and poorly controlled diabetes. - Clinical presentation: Elevated fasting sugar, high HbA1c, complications of chronic liver disease. - Treatment strategy: Transitioning from premix insulin to basal insulin, adjusting insulin dose using a standardized formula, optimizing oral anti-diabetic drugs based on safety profile in liver disease. 18:15 *🩺 Managing Diabetes Case 3: Type 1 Diabetes Diagnosis* - Patient profile: 26-year-old male presenting with severe hypoglycemia and ketosis, diagnosed with type 1 diabetes. - Initial management: Hospitalization, IV fluids, insulin infusion to manage diabetic ketoacidosis. - Transition to outpatient care: Switching to basal-bolus insulin regimen, individualizing insulin dose based on mixed meal stimulation test, ongoing monitoring and adjustment of insulin therapy. 27:16 *📊 Understanding Patient's Diabetes Type* - C-peptide levels and post-meal C-peptide less than six indicate insulin requirement. - A proprietary scoring system suggests the patient is unlikely to have type one diabetes, but follow-up is necessary. - The patient presents with good endogenous insulin production but experienced ketosis, raising uncertainty about the diabetes type. 29:09 *💉 Transitioning to Insulin Therapy and Medication Management* - Gradually replaced short-acting insulin with basal insulin and introduced oral agents. - Caution against prescribing SGLT2 inhibitors due to the risk of ketosis. - Adjustment of medications based on glycemic control and patient response. 30:06 *🔄 Patient's Follow-Up and Management Challenges* - Emphasizes the importance of continuous monitoring and reporting to prevent complications. - Patient's recurrence of ketosis underscores the need for vigilant monitoring and timely intervention. - Uncertainty persists regarding the patient's diabetes type, leaning towards a severe form of type two with impaired beta cell function. Made with HARPA AI