63-year-old male with diabetes for seven to eight years (BbA1c consistently between 5.9-6.5, fasting blood sugar around 7, other times high between 8-9-9.5, no low blood sugar). CKD for five years (starting with 24-hour urine protein within 200, GFR around 100, but in the last 1-2 years urine protein between 300-400mg, GFR between 60-70, most recent one being 56). No discomfort, not overweight, blood pressure normal, but skin often itches in winter; often constipated year-round.

Current medication: 1. Allisartan Tablets 240mg/day 2. Dapagliflozin Tablets 10mg/day 3. Metformin HCL 500mg*3/day 4. Pancreatic kininogenase enteric-coated Tablets.

Are there any better treatment options and medications available? Avoid or delay dialysis if possible. Are there any other exams that need to be done? What are the recommendations for exercise and diet in addition to medication? When should the above medication be switched to insulin due to CKD?

Based on the information provided , it is important to note that the patient has both diabetes and chronic kid ney disease ( CK D ). It is important to manage both conditions simultaneously to prevent complic ations and improve overall health . \n \n Reg arding medication options , it is important to continue taking the current medications as presc ribed by the healthcare provider . However , it may be beneficial to consider adding a medication that can help lower blood sugar levels , such as a sul fony l ure a or an S GL T 2 inhib itor . These medications can help improve g ly ce mic control and potentially slow the progress ion of C K D . \n \n In terms of avoiding or delay ing dial ysis , it is important to work closely with the healthcare provider to determine the best course of action . D ial ysis may be necessary if the patient ' s kid ney function continues to decline or if there are other complic ations related to C K D . \n \n Add itional exam s that may be necessary include a kid ney bi ops y to determine the underlying cause of the C K D , as well as regular monitoring of blood sugar levels , blood pressure , and kid ney function . \n \n In terms of exercise and diet , it is important to work with a healthcare provider or registered diet it ian to develop a personal ized plan that takes into account the patient ' s specific needs and limitations . Regular physical activity , such as walking or swimming , can help improve blood sugar control and overall health . A healthy diet that is low in sod ium , sat ur ated fat , and added sug ars can also help improve kid ney function and manage diabetes . \n \n Reg arding switching to ins ulin , this decision should be made in consultation with the healthcare provider . Ins ulin may be necessary if other medications are not effectively controlling blood sugar levels , or if there are other complic ations related to diabetes . However , it is important to note that ins ulin can increase the risk of hyp og ly ce m ia ( low blood sugar ) and may not be suitable for all patients with C K D . </s>