How can I manage hypoglycemic episodes in a diabetic patient under antidiabetic medication?

Question

Hello doctor,

I am a specialist doctor and wanted to consult you regarding advice for a patient.

A 50-year-old patient was recently discharged from the hospital with symptomatic (slurred speech and confusion) hypoglycemic episodes with glucose levels of 36 mg/dL. The patient is on a regimen of five oral anti glycemic medications (Metformin, Sitagliptin, Pioglitazone, Glimepiride, and Meglitinide full doses) and basal Insulin Glargine of 35 units. I ordered an A1C test for the patient, which showed a value of 6.4 %. I discontinued Glimepiride and Meglitinide and decreased the night-time basal Insulin to 25 units. However patient continues to have morning fasting hypoglycemic episodes ranging from 50 to 70 mg/dL and is asymptomatic. Lunch and breakfast glucose levels range between 170 to 300 mg/dL. The more I try to titrate the Glargine down, the higher the lunch and dinner glucose. Recently I decided to start SLGT-2 inhibitors for her as I continue to decrease the long-acting Glargine. Would you please suggest a treatment plan for the patient to prevent further hypoglycemic episodes?

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

The following are my suggestions:

1. Stop all oral diabetes tablets.

2. Stop basal Insulin at night.

3. Start plain Insulin four times a day according to the random blood sugar (RBS) value on the glucometer.

I hope I have solved your query.

Thank you.