Suggest Ways To Control Diabetes In An Elderly Person

Brief Answer:
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Detailed Answer:
Hello,

Firstly, his kidney disease is causing his blood pressure problem and his blood pressure and diabetes is aggravating his kidney disease, so it's a vicious cycle. In prescription i don't see any anti-diabetic drugs and also no Ecosprin Av in recent prescription which is important. So our target is target is tight control of both BP and sugar to keep disease under check.

Optimization of blood pressure in kidney patient is crucial and difficult step as very high tendency for high BP and fluctuations. So he should keep meticulous record his bp three times a day for a week and then once or twice a week. He should make a chart of it and upload it. So by seeing the readings and timing of high BP we would adjust the dosing.

Calcigard (nifedipine) also to some extent causes fluid retention and swelling of the feet. So we should replace it with tab Cilnidipine 10 mg once a day. It has less chances of swelling in feet.

Also, he should restrict salt which he is already doing and liquids like water tea coffee etc in order decrease chances of swelling. Next, if blood pressure is not adequately controlled then we need to add minipress XL 2.5 mg twice a day or 5 mg once a day, both are viable option. We will add at the time whenever his BP is on higher side.

If BP is more in the evening then we will start in the evening. So at this stage, we should replace minipress with Cilnidipine, as replacing calcigard with minipress will bring back prior problem of swelling. Calcigard and Cilnidipine are same class drugs, both are calcium channel blockers. Now a days, calcigard is rarely used for blood pressure control as we have better newer drugs like Cilnidipine or amlodipine.

Don't worry, just monitor the blood pressure and there are lot many drugs available and BP can be controlled very well. Our target systolic blood pressure is 110-140.

Any stress say vomiting can also increase BP. Nausea and vomiting is probably because of gastritis and acidity which is common in kidney patients.

Does he also have upper abdominal pain, nausea, bloating, burping, increase in pain on food, sour water feeling in throat or chest burning ? as these are other associated symptoms.

He should avoid fatty, oily and high calorie diet. Have some walk after having food instead of taking rest. Have multiple small meals instead of heavy meals. Have regular sleep habits and avoid stress. Lots of green leafy vegetables, fruits. Avoid smoking and alcohol if any. He can get prescribed cap Rabeprazole-Domperidone combination (20/30) mg before breakfast once a day for 2 weeks then whenever needed. Also, along with this he should have syr Sucralfate or Gelusil two teaspoon three times a day for a week.

He need to have a healthy lifestyle like avoiding fatty, oily, sweets and high calorie diet. Have low salt diet and monitor blood pressure regularly as advised. Regular exercises like brisk walking, jogging according your capacity at least 30 min a day and 5 days a week.

Lots of green leafy vegetables, fruits, fish once or twice a week, avoid meat. Avoid smoking and alcohol if any. There shouldn't abdominal fat deposition or obesity.

I hope that's help you, do get back if you have any further questions.
Regards

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