instruction: hello doctor my dad has type diabetes he is on insulin 14 my a day and twice on some days he has been having severe stomach pain for weeks and now he has lost a lot of weight since being on insulin his feet have become swollen and his eyes yellow prior to insulin he was on metformin but his blood sugar was still high now he is suffering more I really do not know what to do now please help should he go back to metformin
output: hi from your history it seems your father is suffering from uncontrolled diabetes mellitus for seven months or more which was not controlled with metformin the present complaints you have mentioned after starting insulin may not be actually related to insulin rather may be due to uncontrolled diabetes or else a systemic disease most probably involving liver in view of jaundice or even a renal problem can cause the same because he is on pain killers ibuprofen which may effects negatively to kidneys in such patients first stop ibuprofen at the earliest make sure insulin is injected at proper site rule out insulin site infections rule out kidney and liver involvement by doing rat renal function test and let liver function test along with blood routine why insulin was directly started after metformin is also a doubt there are many good oral tablets which are stronger than metformin that may be tried before insulin if no contraindications weight loss may be due to uncontrolled sugars which are signified by blood sugars postmeal liver function test renal function test complete blood count with ear erythrocyte sedimentation rate hba1c glycated hemoglobin proper diabetic diet regular aerobic exercises for 30 minutes per day insulin maybe continued special care on storage site of injection methods of injecting may be shifted to anti diabetic tablets once the patient is stable