Dr. M V Srinivas (Emergency Medicine) needs a second opinion on this medical case.
54 Female weighing 90kg known HTN came with a c/o intermittent fever with chills on and off. Test for Malaria under microscope negative. Salmonella negative. H/o Burning micturition 3weeks back and having vaginitis as i understood by her words. Complete urine analysis - lot many pus cells. Urine sent for culture. Immediately she was started on Glevo 500 daily once for 1 week and Niftas 100 mg twice daily for 7days blood investigations further revealed FBG 260 PPBG 330 S URIC ACID - 6.3 LFT NORMAL BLOOD UREA AND S CREATININE WITHIN NORMAL LIMITS FASTING LIPID PROFILE - TGL 360 Total Cholesterol - 214 VLDL 72 HbA1c 12.4 Thyroid profile and urine for ketones - Waiting As this is freshly diagnosed dm case whats the next step of management? Apart from lipid lowering agents Shall we start with metformin and sitagliptin/Glimepiride or Insulin have to be started immediately with the above drugs combination ?
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