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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