A fatty (BMI >38) female patient 67 yrs old retired teacher and Yoga trainer too having T2DM is in Human mixtard Insulin in 25 - 30 IU dose Bd. Duration of T2DM > 18 yrs and previously on OHA,now despite combination therapy her blood sugar is not controlled.Additionally she is prescribed Vidagliptin and Metformin.On normal diabetic diet.She is having severe grade of Peripheral neuropathy leading to intense pain of lower limbs and numbness.I prescribed Amitryptiline and Pregator.But her problem still continues.1st inadequate blood sugar control and 2nd her neuropathic pain.
Whad additional managemement we shoud think ? Her hepato -renal profile are within range.Uric acid in normal(upper) range.
