Case Study: Why Is This Patient’s Diabetes Not Under Control?

General
, ,
1

Patient Profile:
•54-year-old male
•Type 2 Diabetes for 8 years

Uncontrolled-Diabetes-Treatment-Strategies
Uncontrolled-Diabetes-Treatment-Strategies1200×802 49.5 KB

-Medications:
•Metformin 1000 mg BD
•Glimepiride 2 mg OD
•Pioglitazone 15 mg OD

Recent fasting glucose: 210 mg/dL
HbA1c: 9.5% (high)

-During counseling, patient admits:
Taking herbal “sugar-lowering” powder daily
Skipping breakfast regularly
Drinks alcohol on weekends
→ What factors could be causing his poor sugar control?
→ Are there any drug-herb interactions to worry about?
→ How would you counsel this patient to improve control?
→ Should his treatment regimen change?

7 Likes
2

Alcohol needs to be stopped.

Sglt2 inhibitors and Dpp4 inhibitors can be given.

3

The patient’s uncontrolled diabetes is likely a multifactorial issue, with lifestyle factors (skipping breakfast, alcohol) and the use of an unproven herbal supplement being major contributors.

Addressing these immediately is paramount.

If control remains poor after these modifications, then a medication escalation, likely involving an injectable agent, would be the next step.

1 Like
4

The patient needs to stop consuming alcohol completely for controlling the type-2 diabetes. This is affecting a lot to the patient and by not quitting this it may lead to organ damage slowly.

5

His diabetes is not well controlled mainly because of his habits. Skipping breakfast can lead to sugar spikes later in the day, and drinking alcohol affects liver function and glucose balance. Plus, taking herbal powders without proper knowledge can interact with his diabetes medicines and reduce their effectiveness.Even though he is taking medications regularly, these lifestyle choices are stopping the treatment from working properly. That’s why his fasting glucose is still high and HbA1c is 9.5%.

He needs proper counseling—like maintaining regular meals, avoiding alcohol, and stopping unknown herbal products. Once these are corrected, his sugar levels might improve. If not, the doctor may have to review and update his medications.

6

The reasons for this patient’s condition is definitely his lifestyle choices like skipping breakfast and consuming alcohol. He needs to control his diet and lifestyle along with medications to improve his health condition. Also the sugar lowering powder must be checked for its safety and efficacy for its use.
Making the patient aware about these factors and consequences is necessary.

1 Like
7

Stopping alcohol intake .
Herbal powder to be taken under supervision of a naturalist

8

Alcohol drinking
May be lack of medication adherence due to intake of herbal medicine

9

Considering the women’s age, I don’t think she drinks alcohol in an amount that it affects her sugar levels that too only on weekends. What concerns me is that her, taking some herbal powder where there could be a chance of potential drug-herb interaction that decreases the effectiveness of the drug.

10

Factors causing poor glycemic control are:

  1. Skipping breakfast- Which increases the blood sugar levels.
  2. Alcohol intake: Affects metabolism of person also damages liver.
  3. Usage of Herbal drug powder: Which could be unapproved, may affect drug metabolism causing herbal+drug interactions.

Counselling points:

A) Lifestyle Modifications:

  1. Eat healthy diet rich in fibres.
  2. Exercise weekly ≥150mins/week.
  3. Avoid Alcohol consumption.
  4. Practice Aerobic meditation.
  5. Maintain daily diet diary.
  6. Stop herbal products use, always consult your doctor before starting any other products.

B) Disease related:

  1. Explain the patient and their relatives about the disease.
  2. Explain all possible symptoms to consider
  3. Explain the situation when blood sugar levels remains high and steps to overcome it.

C)Drug related:

  1. Explain the use of each medications to patients and their family.
  2. State the importance of medication adherence.
  3. Explain all possible drug-drug ,drug-food interactions.
  4. Provide guidance on missed doses.
  5. State the importance of time of adminstration of medications.

Should treatment regimen change :
Yes, should add SGLT2 inhibitor (eg: dapagliflozin) or any other Evidence based medicine to the therapy.

11

thanks for sharing.

1 Like