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In this case, 54y/0, LADA with positive GAD antibodies, and strong family H/O DM , and HBA1c 8%, low BMI, a combination of metformin with DPP–4 inhibitors, or SGLT2 inhibitors, with Vitamin D3 can be considered (in place of insulin); further consider to rule out other auto-immune disorders such as thyroid dysfunction ... etc. Thank you.
I have a similar patient with a similar story. Again, intolerance to injectable GLP one therapy and SGL T2 inhibitor therapy resulted in significant and severe dyslipidemia. Currently, and for physiologic replacement and believe it or not, seems to have better glycemic control on Janumet than when on a GLP1 , Possibly due to glucagon suppression. The curious thing was the better glycemic control while on DPP4 Which makes me question his adherence with GLP one. As a rule, I stay way from SUs
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