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How to manage uncontrolled diabetes, blood pressure, and diarrhea that occurred after five years of immunosuppressor treatment?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hi doctor,

After five years of treatment with Prednisone for an auto-immune disease and immune suppressor treatment with Actemra in 2017, I developed uncontrolled diabetes, blood pressure, and uncontrolled diarrhea. With the help of an online cardiologist, my BP is controlled with a very low dose of treatment (Spironolactone 25 mg and Telmisartan 40 mg). The only treatment that worked was Forxiga, but I had a very bad UTI. For diarrhea, I discovered I have the FUT2 gene non-secretor type. After the stool test was confirmed, I did not have bifidobacteria - taking one pill of Bifido solved the nightmare of five years of horrifying diarrhea. For diabetes, my doctor is increasing and increasing and adding pills without any effect. My treatment at this moment is as follows: 5 mg Glyburide morning and night, Trajenta after lunch, and Glumetza 500 mg and Glyburide at night. I am on medications Forxiga and Trulicity. Even after two days of not eating, my sugar is between 10 and 11 in the morning; my HbA1c is more than 8. I am 69 years old with a height of 5 feet 3 inches, and weight of 194 pounds (I gained 33 pounds last year after treatment with Gliclazide when I was hungry day and night).

Answered by Dr. Thiyagarajan. T

Education:

MBBS

Professional Bio:

Dr. Thiyagarajan T is an eminent Endocrinologist specializing in the diagnosis and management of hormonal and metabolic disorders. He has expertise in diabetes, thyroid disorders, osteoporosis, adrenal and pituitary disorders, and obesity management. Known for his patient-centered approach, Dr. Thiyagarajan combines advanced diagnostic techniques with personalized treatment plans to optimize hormonal health, improve quality of life, and support long-term well-being.

This doctor is not available for online consultations on the platform anymore.

Hi,

Welcome to icliniq.com.

I understand your concern. Please answer the following questions for better understanding. Are you still on Prednisone? Did you get any side effects from Trulicity? Did Trulicity make diarrhea worse? Have you considered insulin? Your CGMS (continuous glucose monitoring system) tracing shows the entire graph shifted upwards, so basal insulin will be the right choice for you. I suggest starting Insulin Degludec 10 units daily. And continue the other medicines - Linagliptin, Glyburide, and Metformin. If you do not want to consider insulin and have no problems with Trulicity (Dulaglutide), you can try either Trulicity or a similar medicine such as Semaglutide (an oral Semglutide is also available). Hope this helps. Kind regards.

Medically reviewed by Dr. K. Shobana
Published At December 25, 2022
Reviewed At June 20, 2024

Education:

MBBS

Professional Bio:

Dr. Thiyagarajan T is an eminent Endocrinologist specializing in the diagnosis and management of hormonal and metabolic disorders. He has expertise in diabetes, thyroid disorders, osteoporosis, adrenal and pituitary disorders, and obesity management. Known for his patient-centered approach, Dr. Thiyagarajan combines advanced diagnostic techniques with personalized treatment plans to optimize hormonal health, improve quality of life, and support long-term well-being.

This doctor is not available for online consultations on the platform anymore.

Education:

BDS

Professional Bio:

Dr. K. Shobana is a Dental Surgeon specializing in oral health and dental care. She is skilled in preventive dentistry and provides oral hygiene education. She can do restorative treatments such as fillings and crowns. She can handle periodontal problems such as gum diseases and periodontitis. She can do root canal treatment.

This doctor is not available for online consultations on the platform anymore.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Education:

MBBS

Professional Bio:

Dr. Thiyagarajan T is an eminent Endocrinologist specializing in the diagnosis and management of hormonal and metabolic disorders. He has expertise in diabetes, thyroid disorders, osteoporosis, adrenal and pituitary disorders, and obesity management. Known for his patient-centered approach, Dr. Thiyagarajan combines advanced diagnostic techniques with personalized treatment plans to optimize hormonal health, improve quality of life, and support long-term well-being.

This doctor is not available for online consultations on the platform anymore.

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