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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Diagnosed With Diabetes Nephropathy, Unconsciousness, Has Blood Urea, Hypokalemia, Hyperglycemia. Taking Medication. What Now?

iam m64 years ols with the history of cabg 1999 , type 2dm from 1999, i also have thye history of htn from last 30 years, in 2005 i was diagnosed with diaqbitic nephropathy ,amount of 24 hors urine protiene varies from 500mg to 1200mg, on 7th of may 2013 i was suffredfrom nausia , veritigo, and vomitting and fall down on stairs and become unconcionus for 10 mints, immediatly i was hospitalized, and ecg was done withj some blood tests, ecg shows sinus berracardiya , heart rate was up to 40bpm , trigrelicyde was up to 425. crtnine was 1.5, blood urea 125 potassium was 3.5... after 5 hours crtnine level was 2.7 , urea was 91 and potassium was 6.9. i was diagnosed with hyperkalimia and pti was done in emergency. now iam discahred from hospital, diagnosed with ARF- syncope and hyperkalimia, i take insulin human mixtard 30/70 17 unit bbf and 15 unit b/dinner. and fasiting level is 200 to 230 and after 2 hours of meal it jumped to 300 to 350 in glucometer. today doc has now advised me to take tab. metformin hydrochloride sustained release ip100mg along with 16 units bbf and one tab. before dinner with 8 units , i want to know should i take this combination , i afraid from hypoglocemia as i was two time hospitalized due to this. pls suggest me the appro. dose to keep my glucose level near to target levels.. i take medicines. aspirin 75 od, tab atrovastran 20 od. tab amlodipine 5mg bd, and iron folic tab.
Wed, 22 May 2013
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General & Family Physician 's  Response
Hello,
Thanks for the query to H.C.M. Forum.
The main aim of combination therapy is to regulate blood sugar level.
Elderly patient may benefit from a more glycemic control because of complications of hypoglycemia ,that are prone to tight control.
The main aim of combination therapy is to control blood glucose level as,
140 mg/dl-150 mg/ dl.
Glycosylated hemoglobin (Hb A 1 C) at 5.7%.

As your sugar level is not under control & you are a Insulin Dependent Diabetes Mellitus case( IDDM) ,so your doctor decided to start a combination therapy.
In I D D M an oral agent at the maximum dose should be added to INSULIN regime to get desired glycemic control.
The insulin dosage is adjusted at 2 weeks intervals to achieve expected glycemic control.
A
Monitoring very closely during first few week is necessary.
A diabetologist will adjust these dosage according to situation.
Hope you have received information as required.
If further any question I will be happy to help.
Good luck.
Dr. HET
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Diagnosed With Diabetes Nephropathy, Unconsciousness, Has Blood Urea, Hypokalemia, Hyperglycemia. Taking Medication. What Now?

Hello, Thanks for the query to H.C.M. Forum. The main aim of combination therapy is to regulate blood sugar level. Elderly patient may benefit from a more glycemic control because of complications of hypoglycemia ,that are prone to tight control. The main aim of combination therapy is to control blood glucose level as, 140 mg/dl-150 mg/ dl. Glycosylated hemoglobin (Hb A 1 C) at 5.7%. As your sugar level is not under control & you are a Insulin Dependent Diabetes Mellitus case( IDDM) ,so your doctor decided to start a combination therapy. In I D D M an oral agent at the maximum dose should be added to INSULIN regime to get desired glycemic control. The insulin dosage is adjusted at 2 weeks intervals to achieve expected glycemic control. A Monitoring very closely during first few week is necessary. A diabetologist will adjust these dosage according to situation. Hope you have received information as required. If further any question I will be happy to help. Good luck. Dr. HET