I completely agree with Dr. Gurudatta. As rightly said, high fasting sugar levels indicate that stress is adding to the production of glucose, this can be the most likely reason for high BSL. Interventions like meditation and Bhramari Pranayam do help to control elevated blood sugar levels.

To add to the whole answer, I suggest to go back and talk to the patient about his diet recall. Many times, unknowingly, patient consumes some foods which add to insulin resistance.

As we all know, fasting blood sugar elevation is a sign of high insulin resistance. The GLUT 4 receptors are not able to allow the blood sugar to enter the muscles in resting state due to being blocked by fatty tissue.

Advise the patient to refrain from following 4 foods

1. Milk. Milk is used in Tea, coffee, Curd, Butter milk, Lassi, cheese, butter, paneer, sweets like ras gulla, pedha, barfi etc. Milk is also used in making of breads, biscuit, Kharee, toast, Pav etc
2. Sugar which includes, Jaggery, Honey, sugar free tablets or liquids and sugarcane juice.
3. Wheat which includes Roti, chapathi, Upma, Sheera, Daliya, Paratha and many more items made up of maida also
4. Rice which includes Poha, Idli, Dosa and Pej also.

High fasting BSL indicates that there is still a huge scope of weight reduction in the patient, the liver still has a huge depot of fats to be utilized.

Advise the patient to have some additional aerobic or strength training exercises to utilize the stored fats.

Few drugs like antibiotics, β-blockers, thiazide diuretics, corticosteroids, cyclosporine and protease inhibitors used for viral infections may elevate blood glucose levels in those with or without diabetes. If so, a judicious call has to be taken for the same.

Doc,

Congrats for treating such a tough case so confidently.

C peptide is a substance made by pancreas along with Insulin. It is not a diagnostic tool but a marker which can help the doctor in his clinical analysis.

Many times differentiating between a Type 1 and Type 2 DM is very difficult especially in a low BMI diabetic patient. At times, we reject the patient considering him untreatable due to him being in low BMI, but our internal research has shown that our Madhavbaug treatment has seen to be equally effective in low BMI DM patients also.

So once again congrats for your success.