Hello Doc,

This patient had suffered a Pulmonary thromboembolic episode in the past. This patient seems to be in Cardiac failure. His Pulmonary hypertension which is seen as PASP 97 mm of hg, is due to fluid congestion.

You can treat this patient and get him out of this problem if you follow the following rules perfectly.

1. Fluid intake should be restricted below 1 litre a day for next 90 days.
2. Calorie intake should be restricted below 800 Kcal a day
3. Patient should consume food only if hungry and should maintain a gap of 10 to 12 hours in between 2 meals.
4. Ask the patient to completely refrain from Milk, Rice, Wheat and Sugar for next 90 days
5. Patient should follow complete NBM for 24 hours once a week for next 12 weeks.
6. Tab Lasix 40 mg should be continued for next 30 days twice a day at 7 am and 1 pm.
7. Virechan once a week will be beneficial
8. About 14 to 21 sittings of HFRT will be helping the patient to improve the force of contraction of his heart. To start with perform the said PK in Propped up position
9. Ask the patient to sleep in night in propped up position only
10. Salt intake to be restricted to 2 gms a day, not more than that.
11. Ask the patient to perform 30 min of Bhramari Pranayam every day.
12. Repeat 2 D echo every 30 days to measure the PASP. At normal, it should be below 20. In a months time we expect the PASP to reduce down to 60. Once it comes down below 50, patient will be out of danger.

All the best! Follow all the above steps and you will win.

I completely agree with Dr. Rahul about HRV being one of the leading cause for fasting BSL in a highly compliant patient.

Along with the above, the weight loss happening for the patient, if pathological, also can be a cause for the high BSL. Markers like LDH, CK can help you to identify the same.

Few medications like Steroids, anti depressants, oral contraceptive pills, Antifungals, antibiotics, Beta blockers, Thiazide diuretics, Statins also can lead to increase in BSL.

Following points to be implemented to prevent relapse of DM post tapering

1. Stop Wheat and wheat related products like maida and Suji for 90 days post reversal. Encourage the patient to consume complex carbs like Jowar, Bajra, Ragii, Besan and other relted products. Any complex carb atta he uses to make his roti, it should not be more than 30 gms in his one meal.
2. Prevent consumption of Milk and milk derived bakery products for 120 days minimum post reversal
3. Rice products to be kept on hold post 90 days of reversal
4. Keeping sugar, jaggery and sugar free products on hold, Even after Prameha diet kit, keep the patient on 800 calorie diet for next 90 days
5. If possible, ask the patient to consume only 2 meals a day for next 90 days post reversal.
6. Ask the patient to maintain a gap of minimum 8 to 10 hours in between these two meals.
7. 7 to 10 cups of salads to be consumed every day by the patient
8. If you plan to maintain the weight of the patient, keeping the sugar level in control, add required proportion of ghee to patients diet to match his calorie requirement.

I am sure, if you educate the patient for above points, you can surely prevent the relapse of disease post reversal.