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?

I am not a doctor , but I can provide some general information and recommend ations based on your situation . It is essential to consult with a health care professional for personal ized advice and treatment options . \n \n 1 . Medic ation options : \n There are several medic ations that could be considered as alternatives or in combination with your current medic ations to manage di ab etes and C K D . These include : \n * S G LT 2 in hib itors ( e . g ., emp ag l if lo zin , can ag l if lo zin , or d ap ag l if lo zin ) \n * GL P - 1 re ceptor ag on ists ( e . g ., li rag l ut ide , sem ag l ut ide , or d ul ag l ut ide ) \n * D PP - 4 in hib itors ( e . g ., sit agli pt in , sa x agli pt in , or lin agli pt in ) \n * Th ia z olid ined iones ( e . g ., pi og lit az one or ros ig lit az one ) \n It is important to discuss these options with your doctor to determine the most appropriate treatment plan for your specific situation . \n 2 . Other ex ams and recommend ations : \n * Kid ney function : Reg ular monitoring of G FR and ur ine protein levels can help assess the pro gression of C K D . Your doctor may recommend additional tests or refer you to a ne ph ro log ist for further evaluation and management . \n * Sk in it ch ing : The cause of your skin it ch ing may not be directly related to your di ab etes or C K D , but it could be due to dry skin or other underlying conditions . Your doctor may recommend a skin exam ination or refer you to a der mat ologist for further evaluation and treatment . \n * Const ip ation : M aint aining ade qu ate hyd r ation , e ating a high - fi ber di et , and regular exercise can help alle vi ate const ip ation . Your doctor may also recommend la x atives or other treat ments depending on the sever ity of your sympt oms . \n 1 . Ex erc ise and di et recommend ations : \n * health y di et and regular exercise are essential for man aging di ab etes and C K D . Your doctor or a registered di et it ian can help you develop a personal ized me al plan that meets your nut r itional needs and helps control your blood sugar levels . Some general recommend ations include : \n * E ating a bal anced di et with plenty of f ruits , veget ables , whole gra ins , and lean prote ins \n * Lim iting processed food s , added sug ars , and s atur ated f ats \n * In cluding health y f ats , such as o live oil and n uts , in your di et \n * Dr inking plenty of water and avoid ing sug ary drink s \n * Eng aging in regular physical activity , such as walking , sw imming , or cy cling , for at least 3 0 minutes a day , most days of the week \n 1 . Ins ul in ther apy : \n In s ul in ther apy may be considered when your blood sugar levels are not well - control led with or al medic ations , or when C K D pro gression is severe . The decision to start ins ul in ther apy should be made on an individual basis , taking into account your specific medical history , current medic ations , and blood sugar control . Your doctor can help determine the appropriate timing for ins ul in ther apy and provide guidance on dos ing and administration . \n \n Ag ain , I am not a doctor , and this information should not be considered as professional medical advice . Always consult with a health care professional for personal ized advice and treatment options . </s>