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How do you manage proteinuria in a patient with type 1 diabetes mellitus who has orthostatic hypotension and is unable to tolerate ACEi/ARBs?
Answer from: at Community Practice
I do agree with Dr. @Ramin Sam that orthostatic hypotension should be evaluated. This could include a 24-hour ABPM and/or careful home BPs + weight monitoring. If dysautonomia is suspected, then seeing a specialist for dysautonomia could be beneficial.Surprisingly, orthostasis symptoms improved with...
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Answer from: at Academic Institution
Difficult question. One needs to assess the severity of the orthostatic hypotension, its cause, and if there is any treatment for it. Ideally, blood pressure control is most optimal in this situation but it may be limited if a patient is having severe symptoms from the orthostasis. SGLT-2 can be con...
Answer from: at Community Practice
Thank you for the insightful responses.