15-04-2025
THIS IA AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[15-04-2025 22:42] PPM 3: Sir he didn't get his post lunch sugars tested, He just had his dinner 15mins back, will check his sugars at 12.00 sir
[16-04-2025 00:15] PPM 3: Sir, 12.00 his grbs is 340mg/dl
[16-04-2025 06:06] PPM 1: Thanks let's check his fasting, post prandial. Two hours post breakfast and lunch today
[16-04-2025 07:19] PPM 3: Ok sir
[16-04-2025 17:16] PA: Today post Lunch readings: 275 mg/dL
Lunch taken at 2:35PM Test done at 4:35 PM
[16-04-2025 17:47] PPM 2: What meds is the patient currently on?
[16-04-2025 17:47] PPM 2: Also, @PPM 1 Sir how was a diagnosis of MODY arrived at?
[16-04-2025 18:08] PPM 1: Off all medicines since few months. Previously on dapagliflozin and metformin for a year.
Diagnosis of MODY made on the basis of the absence of type 2 clinical phenotype and history of long term diabetes in father without any complications since 30 years and no complications in patient inspite of nil medicines since few months
[16-04-2025 18:13] PA: Sir patient's father has been under medicines since 30 years. But I don't know the exact medicine. And in genaral the patient has not much difficulty in daily life just that at times he feels thirsty and lips get dry. But the readings are keeping me worried.
[16-04-2025 18:20] PPM 1: Don't worry. We'll fix them easily. Please share all the readings
[16-04-2025 18:40] PPM 2: Why the assumption that MODY does not cause vascular complications? Only Type 3 and 2 don't and they are very indolent and don't generally cause sugars to be in the 2 to 300s
[16-04-2025 18:41] PPM 2: Can you describe the patient's symptoms? When was he absolutely normal and when did symptoms start?
[16-04-2025 21:10] PA: The patient wasn't diagnosed diabetic till 2023 Dec. At 2024 1st quarter accidentally when tested then Blood sugar levels were as high as above 300. And then he got treated with Zuccapride and Gluconorm from then till nov 2024. And in nov 2024 when he got checked at Bangalore his HBA1c was 5.9 and then doc cancelled the Zuccapride and from then till now he is taking only Gluconorm after dinner. But since Doctor suggested that he was not diabetic as per his results, he started eating everything without regulations from nov 2024 till now.
[16-04-2025 21:10] PA: Attaching test results.
[16-04-2025 21:14] PPM 1: Please take care to deidentify the patient to preserve his privacy and confidentiality
[16-04-2025 21:14] PA: Ok sir.
[16-04-2025 21:15] PA: Just now checked sugar levels before dinner it is 288 mg/dL.
[16-04-2025 21:15] PA: From last tests till now I have eaten puffed rice, a slice of mango, some cucumber peices and a small cup of tea.
[16-04-2025 21:48] PPM 2: Thanks for sharing. Did the patient (as you are the patient's advocate) ever get a formal Fasting and Post prandial blood sugar tests?
[17-04-2025 08:55] PA: Good Morning Sir.
[17-04-2025 08:57] PA: Today fasting tests has been done of patient and readings are 190 mg/dL at 8:56AM. Last meal taken on last night 9:28 PM.
[17-04-2025 09:12] PPM 1: We'll start you on pharmacological treatment and all of that will be controlled. Don't worry.
Are your patients currently on the way to LB Nagar by ambulance? @~PPM 5 I guess you are accompanying them?
[17-04-2025 11:36] PA: 2 hours post breakfast sugar is 327 mg/dL.
Breakfast taken - puffed rice, chira, chatu and half banana.
[17-04-2025 12:20] PPM 1: Let's start your patient on tablet Glimiperide 1 mg before breakfast from today. Tablet Metformin 500 mg after every meal thrice
[17-04-2025 20:10] PA: Sir in the pharmacy here they are saying that they don't have this two medicines separately
They have a medicine which is combination of those. What should I do?
[17-04-2025 21:39] PPM 1: What is the patient's current sugar? Can purchase it from the pharmacy outside
[17-04-2025 22:10] PA: Tonight before dinner Blood Sugar Tested and found readings 267 mg/DL.
[17-04-2025 22:11] PA: Today unable to go outside tomorrow will start the medicine.
[18-04-2025 09:36] PA: Good Morning Sir.
[18-04-2025 09:37] PA: Started medicine today. Took glimiperide 1 mg at 9:20 AM and tested fasting Blood sugar now readings are 204 mg/dL. Now taking breakfast.
[18-04-2025 09:38] PPM 1: Fasting 204 today?
Test again exactly after two hours after taking the glimiperide
[18-04-2025 09:55] PA: Ok.
[18-04-2025 12:26] PA: Sir missed the spot of exactly 2 hours after due to continuous support to my wife and other things. But tested at 12:15 PM and results were 298Mg/DL
[18-04-2025 12:27] PA: It's about 2:40 minutes after taking glimiperide.
[18-04-2025 12:29] PA: Have taken just 1 dose of glimiperide before breakfast and 1 dose of metformin after morning meal. Medicines started today.
[18-04-2025 12:51] PPM 1: Let's keep seeing the blood sugars two hours after every meal and fasting tomorrow and then we can uptitrate the dose of glimiperide if necessary, slowly over days to weeks
[18-04-2025 13:04] PA: Sir does tension and stress increase blood sugar levels!
[18-04-2025 16:18] PPM 1: Yes
[18-04-2025 16:48] PA: Today Lunch completed at 2:10 PM and Post Lunch sugar tested at 4:10 and results are 172mg/DL
[18-04-2025 16:55] PPM 1: Yes, although not to the point one would imagine.
[19-04-2025 09:16] PA: Yesterday 2 hours post dinner Blood sugar levels 188 mg/DL.
[19-04-2025 09:16] PA: Today Fasting Blood Sugar Levels are 170mg /DL.
[19-04-2025 10:24] PPM 1: Keep measuring two hours after every meal
[19-04-2025 11:56] PA: 2 hours after breakfast sugar levels 232mg/DL
[19-04-2025 11:59] PPM 1: From tomorrow we could increase the dose of glimiperide to 1.5 mg
Hope he's also taking Tablet Metformin 500 mg after every meal?
[19-04-2025 19:00] PA: Yes.
[20-04-2025 08:37] PA: Good Morning Sir.
[20-04-2025 08:39] PA: Tomorrow readings of 2 hours post dinner 172mg /DL
[20-04-2025 08:41] PA: Today Morning Fasting Blood Sugar Readings 159mg/DL. I have not taken the glimiperide 1.5 mg till now. Now I will take glimiperide 1.5 mg and after 15 mins I will take my breakfast.
[20-04-2025 08:42] PA: Sir apart from medicine diet is also mentioned in the OP slip but which diet should I follow can I get in detail.
[20-04-2025 11:34] PA: Sir my readings 2 hours after breakfast was 195mg/DL
[20-04-2025 11:56] PPM 1: This diet is for everyone.
All human beings including diabetics are supposed to take this normal diet. Unfortunately most normal human beings don't take this normal diet 👇
https://medicinedepartment.blogspot.com/2023/09/the-healthy-plate-diet-in-bengali-telegu.html?m=1
[20-04-2025 12:10] PA: Sir I am worried that why my sugar levels not coming to normal like other people's. Although I have been taking medicines from last 3 days. Is it due to tension and stress or it will take some time.
[20-04-2025 12:12] PA: It is down from levels like 270 and 300 but still it's roaming between 160 -190.
[20-04-2025 12:13] PPM 1: Please be careful not to identify your patient while discussing about him online to protect his privacy.
The sugars are much less than 250 when he restarted medicines aren't they?
As you can see it's very easy to bring it down and we should try to bring it down gradually and not be in a hurry as that can cause more side effects
[20-04-2025 12:15] PA: Ok sir. I am grateful that you have guided the patient. And I will convey this message to him.
[20-04-2025 12:16] PA: Yes the levels are less now than beginning. I will ask him to have patience and follow the diet.
[20-04-2025 16:39] PPM 2: Please could you tell us what is your patient's understanding of Diabetes?
[20-04-2025 19:28] PA: According to him diabetes is a condition in which body's blood sugar levels rises which in turn affects different organs in long term.
But since last nov when he tested his HBA1C was 5.9 and now after 4-5 months when he tested here and levels come as high as 292 and 343 at the beginning. So he was worried.
[20-04-2025 19:29] PA: But now after he got guidance from here and now after taking medicines his levels are decreasing gradually.
[20-04-2025 19:49] PPM 2: Yes that is correct and what is your patient's understanding of why blood sugars rise?
[20-04-2025 23:56] PA: Today blood sugar levels 2 hours after dinner 212 mg/DL.
[21-04-2025 07:00] PPM 1: Ask the patient to take glimiperide 2 mg today before breakfast
[21-04-2025 07:00] PPM 1: Is the patient also taking metformin 500 mg after breakfast, lunch and dinner?
[21-04-2025 07:02] PA: Good Morning Sir.
[21-04-2025 07:03] PA: Yes the patient is taking Metformin 500 mg after breakfast lunch and dinner.
[21-04-2025 07:04] PA: Ok I will ask the patient to take Glimiperide 2 mg from today.
[21-04-2025 07:15] PA: Today fasting Blood Sugar levels are 156 mg/DL
[21-04-2025 07:49] PPM 1: Will be keen to know the two hour post breakfast and post lunch and post dinner today
[21-04-2025 07:54] PA: Okey Sir.
[21-04-2025 08:17] PA: Sir it will be very helpful if you allow us to take discharge of patient 24F and Patient 32F today 1st half. We need to visit Nalgonda in a friends place.
[21-04-2025 12:03] PA: 2 hours after breakfast blood sugar levels 164mg/DL
[21-04-2025 13:19] PPM 1: @~PPM 3 please share their draft discharges without the identifiers here
[21-04-2025 13:38] PPM 3: Ok sir
[21-04-2025 16:56] PA: Today 2 hours post Lunch Blood Sugar levels 178 mg/DL
[22-04-2025 00:06] PA: Yesterday 2 hours after dinner Blood sugar readings 226 mg/DL.
[22-04-2025 00:07] PA: At dinner patient took chapati with quash sabji and some amount of rice with some masoor dal and alu sedho.
[22-04-2025 07:43] PA: Good Morning.
[22-04-2025 07:44] PA: Today Fasting blood Sugar levels 148 mg/DL. Dinner completed at night 9:44 PM. 10 hours after dinner readings taken.
[22-04-2025 07:50] PPM 1: We can add 0.5 mg of glimiperide before dinner from tonight
[22-04-2025 07:51] PPM 1: 👆 Although this change need not be from tonight as the patient is traveling today but can wait till he reaches home but hopefully he will continue to report his daily blood sugars before we think of adding the night dose
[22-04-2025 07:53] PA: Ok.
[22-04-2025 07:54] PA: Yes the patient will be travelling tonight. And he will continue updating his blood sugar levels. And will inform once he reaches home.
[23-04-2025 11:34] PA: Today fasting blood sugar levels 142mg/DL
And 2 hours after breakfast readings are 171mg/DL
Since in train so unable to follow proper diet.
[23-04-2025 13:11] PPM 1: The patient is taking 2 mg of glimiperide before breakfast and 500 mg of metformin after breakfast and lunch and dinner?
[23-04-2025 13:11] PA: Yes.
[25-04-2025 11:47] PA: Good Morning.
[25-04-2025 11:48] PA: Patient has reached home and started testing again. Medicine he is taking is 2mg glimiperide at morning before breakfast and 500mg of metformin after breakfast, lunch and dinner.
[25-04-2025 11:51] PA: Today his fasting blood sugar levels are 140 mg/DL and 2 hours after breakfast is 198 mg/DL. Breakfast taken is 2 peice multigrain atta roti. 1 small bowl rice with sabzi and 1 peice fish. After breakfast took metformin and after 2 hours taken this reading.
PPM 1: 👍
[30-05-2025 08:28] PA: Good Morning Sir.
[30-05-2025 08:28] PA: The patient has started monitoring Blood Sugar from today again.
[30-05-2025 08:28] PA: He has been taking Glimiperide 2mg at morning before breakfast and Metformin 500 mg 3 times a day after breakfast, lunch and dinner.
[30-05-2025 08:29] PA: His readings today morning 137mg/Dl
[30-05-2025 08:33] PPM 1: Fasting?
[30-05-2025 09:13] PA: Yes
[30-05-2025 09:14] PA: Last readings were of 23rd April 2025:-
Today fasting blood sugar levels 142mg/DL
And 2 hours after breakfast readings are 171mg/DL
Since in train so unable to follow proper diet.
[30-05-2025 09:30] PPM 1: Fasting was 137 or 142?
Where is the patient traveling from and to?
[30-05-2025 09:39] PA: Sir patient was travelling from Narketpally to Coochbehar. And due to his job location transfer at rural area and other reasons he couldn't record data last 1 month.
The last reading was taken when he was returning from Narketpally which was fasting and reading was 142mg/DL.
[30-05-2025 09:40] PA: Today onwards patient has started monitoring his readings since now he is settled in his new place of posting.
[30-05-2025 09:40] PA: Today's fasting was 137mg/DL.
[30-05-2025 09:41] PA: And he is on medicine all through these days.
1. Glimiperide 2 mg before breakfast once in a day.
2. Metformin 500mg thrice in a day after meals.
[30-05-2025 09:43] PA: The last readings was of 23 April 2025. After that he has been unable to record readings until today. Meanwhile he was taking the prescribed medicines regularly.
[30-05-2025 10:18] PPM 1: Okay now it's much more clearer. Our daily blood sugar recordings values are only relevant for that particular day and at the most the next day and if someone is monitoring regularly then to calculate the average. Beyond that a sugar value of 23rd April may not have any current use.
[30-05-2025 10:18] PPM 1: Please share his two hours after breakfast, lunch and dinner today or at least one holiday in a week
[30-05-2025 10:56]PA: Ok Sir.
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