alexa

GET THE APP

Dersleri yüzünden oldukça stresli bir ruh haline sikiş hikayeleri bürünüp özel matematik dersinden önce rahatlayabilmek için amatör pornolar kendisini yatak odasına kapatan genç adam telefonundan porno resimleri açtığı porno filmini keyifle seyir ederek yatağını mobil porno okşar ruh dinlendirici olduğunu iddia ettikleri özel sex resim bir masaj salonunda çalışan genç masör hem sağlık hem de huzur sikiş için gelip masaj yaptıracak olan kadını gördüğünde porn nutku tutulur tüm gün boyu seksi lezbiyenleri sikiş dikizleyerek onları en savunmasız anlarında fotoğraflayan azılı erkek lavaboya geçerek fotoğraflara bakıp koca yarağını keyifle okşamaya başlar
Back to Oral Hypoglycemic Drugs after Ten Years of Insulin Injections: An Egyptian Case Study

Journal of Clinical and Experimental Endocrinology
Open Access

Our Group organises 3000+ Global Conferenceseries Events every year across USA, Europe & Asia with support from 1000 more scientific Societies and Publishes 700+ Open Access Journals which contains over 50000 eminent personalities, reputed scientists as editorial board members.

Open Access Journals gaining more Readers and Citations
700 Journals and 15,000,000 Readers Each Journal is getting 25,000+ Readers

This Readership is 10 times more when compared to other Subscription Journals (Source: Google Analytics)
  • Editorial   
  • J Clin Exp Endocrinol 2: e105, Vol 2(1)

Back to Oral Hypoglycemic Drugs after Ten Years of Insulin Injections: An Egyptian Case Study

Mina T Kelleni1,2*
1Department of Pharmacology, College of Medicine, Al Jouf University, Sakaka, Kingdom of Saudi Arabia
2Department of Pharmacology, Faculty of Medicine, Minia University, Minia, Egypt
*Corresponding Author: Mina T Kelleni, Department of Pharmacology, College of Medicine, Al Jouf University, Sakaka, Kingdom of Saudi Arabia, Tel: +201200382422, Email: [email protected]

Received: 17-Jan-2018 / Accepted Date: 18-Jan-2018 / Published Date: 25-Jan-2018

Editorial

In my clinical practice, the author noticed many diabetic patients who were inappropriately prescribed insulin injections after failure of oral hypoglycemic drugs to maintain adequate glycemic control. In this editorial I’ll present one of these cases addressing briefly the reasons for this malpractice, how to avoid and more importantly how to suspect and manage.

A slim 53 years old Egyptian diabetic female came to my clinic suffering from recurrent abscesses, her diabetic history revealed that she were on different doses of gliclazide and metformin for 8 years and her physicians changed the regimen to be twice daily injections of biphasic isophane insulin 30/70 for ten years. I’ve ordered hemoglobin A1C (HbA1C) and found it to be 9 confirming the elevated fasting and postprandial blood glucose readings as well as the inadequate glycemic control.

Added to the antibiotics, I’ve started to add 10 units of insulin glargine and reduced 15 units of her previous insulin regimen and I’ve also stressed the crucial importance to avoid stress and nervousness as much as possible in addition to a short summary of the balanced diet beneficial for diabetic patients. The patient was so enthusiastic and the abscesses were treated and more importantly didn’t recur. Within 9 months she’s experienced improved quality of life to the extent that she’s consulted me to stop insulin glargine intake after three months and I’ve approved her request and continued the low dose of modified biphasic insulin regimen without noticing any remarkable increase in the blood glucose readings. Further, I’ve noticed a steady decrease of HbA1C readings to 7, 6 and eventually 5 and at that time I’ve asked for a consented trial of vildagliptin 50 mg and metformin 1000 mg to totally replace the insulin and this new regimen proved valid both clinically and laboratory for her helped by the highly elevated mood she’s experienced after stoppage of insulin shots. Within the next six months, she’s experienced uncontrollable stressful life conditions and I’ve added glimepride 2 mg to the new regimen to overcome the recurrent moderate elevation of blood glucose readings and the modified regimen proved valid for her controlling the blood glucose readings and the HbA1C remained below 7. I’ve also managed several “suspected” patients in a similar manner obtaining similar results though the duration of insulin intake was shorter.

Unfortunately, due to the lack of appropriate medical knowledge provided to the public in the developing countries; diabetes mellitus still has a very bad stigma horrifying millions of type 2 diabetic patients especially when the doctors decide to prescribe insulin injections. Though it’s well known that insulin should be given temporarily to type 2 patients like those prepared for major operations or suffering from infections, some doctors readily prescribe insulin to type 2 diabetic patients immediately after they notice elevation of blood glucose readings and most doctors don’t reconsider their decision after achieving adequate glycemic control. The patient represented in this case was, most probably, suffering from an acute insulin resistance caused by stress hormones and proinflammatory cytokines [1]. Additionally, she’s experienced many of the deleterious dietary and emotional stressors encountered in the modern way of life [2] and the psychological stress was also shown to alter hepatic responsiveness to insulin and affect whole-body glucose metabolism [3].

From my point of view as well as my clinical experience, I recommend to carefully monitor every type 2 diabetic patient who is switched to insulin injections and I believe many of them may return back to oral hypoglycemic drugs and it’s better to suspect early and manage properly.

References

Citation: Kelleni MT (2018) Back to Oral Hypoglycemic Drugs after Ten Years of Insulin Injections: An Egyptian Case Study. J Clin Exp Endocrinol 2: e105.

Copyright: © 2018 Kelleni MT. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Select your language of interest to view the total content in your interested language

Post Your Comment Citation
Share This Article
Article Usage
  • Total views: 1280
  • [From(publication date): 0-2018 - May 19, 2022]
  • Breakdown by view type
  • HTML page views: 953
  • PDF downloads: 327
Top