What are the best ways to manage RA alongside diabetes?

Question

Hello doctor,

My sugar levels are high. Currently, I am taking 12 units of insulin in the morning and at night before food. How can this be resolved? Breathlessness occurs when walking short distances.

Rheumatoid Arthritis: Sometimes there is pain in the finger joints, leg joints, cheeks, and left or right shoulders.
Previously used Predmet 4 (Methylprednisolone Tablets IP) but stopped due to high sugar levels and is now taking Detcort 6 (Deflazacort 6mg).

Current Medications:

Morning (before breakfast)-

Biphasic Isophane Insulin injection, 12 units (Human Mixtard 40 IU/ml, morning and night).
Pantacid (Pantoprazole Tablets, 40 mg).
Sompraz D40 (Esomeprazole Magnesium and Domperidone SR Capsules).

After a gap of 1 hour:

Telmisartan Tablets IP, 40 mg.
Nicorandil Tablets IP (Nikoran 5), 5 mg.
AB Phylline (Acebrophylline Capsules, 100 mg).

Afternoon (2:00 PM)-

Aspisol 75 (Aspirin and Glycine Tablets).

Night-

AB Phylline (Acebrophylline Capsules, 100 mg).

After Dinner-

Triozac (calcium and zinc soft gelatin capsules).
Lefra 20 (Leflunomide tablets IP (Indian Pharmacopoeia).
Aztor 40 (Atorvastatin tablets).

Inhalers-

Tiova inhaler.
Maxiflo inhaler 250.

Please guide.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for posting your query.

I have tried multiple times to open your file (.pages) format, but unfortunately, I could not access it either. Could you please resend the reports and medicines in one of these formats?

From what I can gather, you are dealing with three major problems: Type 2 diabetes mellitus (a chronic condition characterized by insulin resistance and elevated blood sugar levels, often linked to lifestyle and genetic factors), rheumatoid arthritis (An autoimmune disorder causing inflammation, pain, and joint damage due to the immune system attacking the body's tissues), hypertension (Persistently high blood pressure that increases the risk of heart disease, stroke, and other health complications), and coronary artery disease(a condition where the coronary arteries narrow due to plaque buildup, reducing blood flow to the heart and potentially leading to a heart attack) . While you are taking the appropriate medicines, I am concerned about the doses and would like to adjust them based on your current reports. Please attach the following:

Latest blood sugar levels (fasting/PP/HbA1c).
2D echo report.
Complete blood count with ESR(Erythrocyte Sedimentation Rate) and CRP (C-Reactive Protein) levels.
Kidney function test (KFT).
Blood pressure readings.
Complete lipid profile.

Based on your current sugar levels, insulin doses can be adjusted, and an oral hypoglycemic agent may be added.

I hope that you get your answer.

Please let me know if you want some help.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I have reviewed all the reports, and the findings are as follows:

Your breathlessness is due to asthma or chronic obstructive pulmonary disease (a group of progressive lung diseases that obstruct airflow and make breathing difficult), not heart disease, as the 2D echo results are within normal limits. For this, you are taking Tiova and Maxiflo inhalers along with AB Phylline.
TSH (thyroid stimulating hormone) is slightly elevated at 6.4. You can start taking Eltroxin 25 micrograms on an empty stomach and repeat the TSH test 45 days after the last test.
Your blood pressure is 140/90, which is nearly normal for your age and well-controlled with medications. Continue taking Telma.
Your HDL(High-Density Lipoprotein) is low, but the rest of the lipid profile is normal. Start Rosuvas 20 mg, once daily at night, as your urea and creatinine levels are normal. Monitor kidney function tests (KFT) every 15 days, discontinue Atorvastatin, and repeat the lipid profile after one month.
Your treatment for rheumatoid arthritis is appropriate and should be continued.
You have iron-deficiency anemia, secondary to rheumatoid arthritis. This can be confirmed with a complete iron profile test. Start taking Fefol-Z once daily for 15 days (stop if you experience abdominal pain or excessive acidity).
Diabetes management is critical, as both fasting and postprandial sugar levels are elevated. I recommend starting Lantus (12 units subcutaneously at night) along with Janumet (1 tablet daily at 2 PM).
Perform self-monitoring of blood glucose levels at fasting, before lunch, before dinner, and at 10 PM. If this is not possible, at least check fasting and postprandial levels for 15 days. Discontinue Mixtard for now, and further management will depend on your blood sugar reports.

I hope that you get your answer.

Please let me know if you want some help.

Thank you.