Case Studies
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| Case Study - III | ||||||||||||||||||||||||||
As Sudesh Kumar appeared to have responded well to the treatment his doctor advised him to continue insulin and added metformin to the treatment starting treatment with 250mg once a day and increasing it to 500mg twice a day over the next month based on the results regular weekly blood glucose monitoring.
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Sudesh Kumar experienced great symptomatic relief over the treatment period. All symptoms viz, headache, easy fatiguability, abdominal pain, bloating, acid eructations, numbness and tingling in the extremities had disappeared. Sudesh Kumar was anxious about how long insulin injections had to be taken and wanted to know from his doctor whether he could be maintained oral therapy alone. As type 2 diabetes is not insulin dependent his doctor decided to give it a try and prescribed him a sulphonylurea in place of Human Mixtard® while continuing metformin. Over the next two years Sudesh Kumar again neglected his diet, failed to take exercise and appropriate medication and forgot to monitor his blood glucose. As a result he developed:
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| The last symptom prompted a visit to his general practitioner who knowing the past history diagnosed it as a case of diabetic foot. He was referred to a surgeon for debridement of the wound and an x-ray revealed that the infection was limited to the soft tissue, with no involvement of bone. Sudesh Kumar was lucky that his foot wound healed within 15 days of proper medical care which included an antibacterial effective against gram positive and gram negative organisms commonly found in diabetic foot wounds, correct wound dressing at appropriate intervals, and control of the diabetic state. His physician had prescribed:
Inj Human Mixtard® 10 units every morning before breakfast and 5 units every evening before dinner. Regular blood glucose monitoring by one touch basic LIFESCAN glucometer over the next 10 days showed a gradual decline in blood glucose levels. Sudesh Kumar was prescribed a combination of sulfonylurea and metformin once the wound had healed and the dose titrated upwards to the maximum recommended. However he presented with similar complaints 3 months later viz.
He was diagnosed as a case of OHA failure and was prescribed again Inj Human Mixtard®10 units every morning before breakfast and 5 units every evening before dinner. |
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| Rationale for treatment Sudesh Kumar was prescribed Human Mixtard® to control his elevated blood glucose level which was at the time of diagnosis 336 mg/dl on fasting. Later he was told to discontinue Human Mixtard® considering the fact that all type 2 diabetes doesn’t require insulin but when his blood sugar was not controlled with all possible combination of sulphonylurea then doctor again recommended him Human Mixtard®. Sudesh Kumar in a classic case of secondary failure. He was prescribed Human Mixtard® 15 I.U. as his body weight was 72 kgs i.e. 0.2 units x 72kg = 14.4 units. The doctor rounded it to 15 and divided dose as 2/3rd in the morning and 1/3rd in the evening. Sudesh Kumar again started feeling well with insulin therapy. He visits his doctor once every 3 months with his latest plasma glucose report, keeps a diary of his insulin doses, and does not neglect to take his daily dose of insulin. He adheres to the prescribed diet and exercise advice. His wife and family members know about his diabetes and take care not to aggravate it. He has stopped smoking on the combined request of his physician, friends and family. He is currently stabilized on Human Mixtard® 10 I.U. before breakfast and 5 I.U. before dinner. |
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