A Short Practice of Clinical Cases

10/12/2025

Put your differential diagnosis?

10/12/2025

ADA Standards of Care 2026: The New Algorithm for Glucose-Lowering Therapy in Type 2 Diabetes

The ADA 2026 reinforces a priorities-first approach:
1️⃣ Reduce cardiovascular & kidney (CVKD) risk
2️⃣ Manage weight
3️⃣ Achieve glycemic goals
4️⃣ Address MASLD/MASH risk
All built on a foundation of healthy lifestyle + DSMES + addressing SDOH.

🔶 1. FIRST PRIORITY: Cardiovascular & Kidney Risk Reduction

A. ASCVD or Indicators of High CV Risk

Preferred: GLP-1 RA with proven CV benefit

Alternative / Add-on: SGLT2i with proven CV benefit

If HbA1c above target → combine GLP-1 RA + SGLT2i

B. Heart Failure (HFpEF or HFrEF)

Preferred: SGLT2 inhibitor

Add GLP-1 RA (proven benefit) if glycemia not controlled or if comorbid obesity

C. CKD (eGFR

The field of diabetes care is rapidly changing as new research, technology, and treatments that can improve the health and well-being of people with diabet

29/11/2025

কি কি ফাইন্ডিং আছে?
রেডিওলজিক্যালি কি ডায়াগনোসিস?

29/11/2025

27/11/2025

Name of Scoring system?
For what condition you have to do?

26/11/2025

Auscultation points of respiratory examination

26/11/2025

Sick Day Rule – Medications to Stop During Acute Illness (SADMANS)

1. S – Sulfonylureas

Examples: glipizide, gliclazide, glimepiride
Reason: Risk of hypoglycemia when food intake is poor.

2. A – ACE Inhibitors

Examples: lisinopril, enalapril, ramipril
Reason: Risk of AKI with dehydration.

3. D – Diuretics

Examples: furosemide, HCTZ, spironolactone
Reason: Risk of volume depletion and AKI.

4. M – Metformin

Reason: Risk of lactic acidosis in dehydration or renal impairment.

5. A – ARBs

Examples: losartan, valsartan, irbesartan
Reason: Risk of AKI with dehydration.

6. N – NSAIDs

Examples: ibuprofen, naproxen, diclofenac
Reason: Risk of renal vasoconstriction → AKI.

7. S – SGLT2 Inhibitors

Examples: empagliflozin, dapagliflozin, canagliflozin
Reason: Risk of euglycemic DKA during acute illness.

When to Restart

Patients can restart these medications when:
• Eating and drinking normally for 24–48 hours
• Hydration status is normal
• No vomiting/diarrhea

Insulin

Do NOT stop insulin → adjust dose instead
Reason: Prevent DKA/HHS.

GLP-1 RAs

Stop if severe nausea/vomiting (rarely needed unless persistent).

Anticoagulants: Continue, unless severe dehydration + bleeding risk.

14/11/2025

I got over 100 reactions on one of my posts last week! Thanks everyone for your support! 🎉

13/11/2025

একটি হার্ট অ্যাটাকের পর মনে রাখা উচিত ।

09/11/2025

X-ray findings please?