Age 25,�male�(History:�h/o stroke�10�yr�old,�recovered�70% but on�bp�medication�for�last�10�years, diagnosed as�type�2 DM @ 19�age�since that�taking�insulin and oral diabetes medicines) From last three months he�has�uncontrollable blood sugar despite�maintaining�all diabetes workout.�(�diet, exercise, sleeping, medication�etc) 1.�Insugen�50/50� 40�unit�morning�+ 40�unit�noons 2.�Metformin�1000+ teneligliptin 20�(noon) 3.NPH�26 unit before sleep�(10 pm)�(added�just 2�weeks�before) Hba1c�is�9.6 ,�after starting bed time�NPH, FBS is�now�getting 140 to 160�ranges�but high�ppbs�(280-320)�range�despite eating less and highly�fluctuations�in�RBS�(RBS�always high)� � Life style:�same food timetable�(low calorie)�/fixed moderate exercise schedule/no�alcohol/no�smoking/etc. What should do�now?�His oral medications�seem�not�working�is there any chance that he�has�type�1�diabetes�instead of�2.�If that's so how confirm that.(He is obese, so the first doctor immediately diagnosed as type�2)�I searched net and found that c-peptide test will do that, so to get correct insulin production should the external insulin need to stop one day before that test.�Or is there any test to check the cause of�hyperglycemia. Please ask�if�need�any further�information.
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Hello, Thanks for the query. I have gone through the details given. It is clear that at present the diabetes is totally uncontrolled. Because he is obese ((BMI 32.57 kgs/Sq meter), doctor must have concluded he has T2 DM. But it is better if you get C-peptide test plus GAD antibodies, to confirm whether there T1 DM. I have a few questions: 1) What is his routine diet? In detail like from early mornong till he goes to sleep. 2) What is the amount of daily exercise being done both interms of time spent and what activity is done? 3) Have the glucose levels remained high right from beginning or has this been noticed recently? 4) Has he been obese all along? 5) What are creatinine, urea and microalbun values? Please come back with these clarifications, then I may be able to guide. Thanks.
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get C PEPTIDE and serum insulin level done , no need to stop insulin
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