Case- A 62-year-old lady, known case of type 2 diabetes mellitus and hypertension since 15 years reported to a diabetologist. She complains of symptoms of hypoglycemia frequently. She is following lifestyle instructions well. Her BMI is 29 kg/m 2 and blood pressure is 130/80 mm Hg. Her current daily prescription includes Metformin 2 gm, Glimepiride 4 mg, Sitagliptin 100 mg, Canagliflozin 100 mg, Amlodipine 10 mg, Atorvastatin 10 mg.
Her investigations are - fasting plasma glucose- 112 mg/dl, HbA1c-7.1%, urine protein 2+, serum creatinine-1.4 mg/dl. Four months back her serum creatinine had been 1.5 mg/dl Her fundus exam reveals moderate nonproliferative diabetic retinopathy. Question - Considering her kidney disease and episodes of frequent hypoglycemia, how should we manage her diabetes? Discussion- This lady suffering from long-duration diabetes and hypertension has kidney disease.…
