56 years female with 24 years history of T2DM experiencing repeated Hypoglycemia both during the day and night time

A female patient aged 56 years, teacher by profession with 24 years history of T2DM/HTN/DYSLIPIDEMIA/POST LASER DIABETIC RETINOPATHY/CHOLELITHIASIS comes to the OPD, with c/o repeated Hypoglycemia both during the day and night time past few weeks. Patient was on Inj H.mixtard 30/70 30-0-30/ Tab.Voglibose 0.2/metformin 500/glimepiride 2mg BID, Atorvastatin (10mg) + Aspirin (75mg) OD, Telmisartan (40mg) + Metoprolol Succinate (25mg) OD. Diet 1000 calories,3 meals with no snacks. Patient has not titrated the Insulin dose during hypoglycemic episode and has not been monitoring Blood sugars at home past 1 month. Last follow up 4 months back Hba1c was 8%.

What could be the cause of hypoglycemia in the above patient?

Low calorie diet

Dose of Insulin

Sulfonylureas

All of the above

What parameter in the investigation suggests the requirement of insulin is less in the current visit?

FBS

Hba1c

BMI

Calorie consumption

Hba1c & Calorie consumption

Which approach do you avoid to manage this case in the In-Patient setting

Reduce Insulin dose / consider to stop insulin

Reduce or Stop Glimepiride

Consider starting SGLT2inhibitors/DPP4inhibitors with Metformin FDC

Modify the Diet plan

What clinical information suggests adding of SGLT2 inhibitors in the above patient?

BMI

Renal Protection

Hypoglycemia

All of the above

Your score is