Effective Combination Therapy for Type 2 Diabetes: Saline Solution and Targeted Medications Show Strong Results

Abstract: This clinical case highlights the successful management of a patient with a history of type 2 diabetes who presented with worsening classic symptoms—increased thirst, hunger, and frequent urination—accompanied by fatigue, dry skin, and unexplained weight loss. After thorough evaluation and diagnostic testing, the patient was admitted for intensive glucose regulation. Treatment included intravenous 0.9% sodium chloride solution, insulin therapy, and oral antidiabetic medications such as metformin and dapagliflozin. Following a five-day hospitalization, the patient showed significant improvement in symptoms, with blood glucose levels stabilized within the normal range, leading to a smooth discharge and transition to outpatient care.

Patient Overview

Age & Gender: 55-year-old maleDiagnosis: Type 2 Diabetes MellitusHospital: Henan Provincial People's HospitalDate of Admission: October 2021Treatment Plan: Subcutaneous insulin injections, intravenous 0.9% sodium chloride infusion, and oral medications (extended-release metformin and dapagliflozin)Duration of Treatment: 5 days inpatient careOutcome: Marked symptom relief and sustained glycemic control

Initial Assessment and Diagnosis

The patient reported a one-year history of polydipsia (excessive thirst), polyphagia (increased hunger), and polyuria (frequent urination), initially diagnosed as type 2 diabetes at an outside facility. He had been prescribed extended-release metformin but admitted to inconsistent adherence, discontinuing the medication once symptoms slightly improved. Over the past two weeks prior to admission, his symptoms worsened significantly, with new-onset fatigue, persistent dry mouth, dry skin, and a noticeable drop in body weight—raising concerns that prompted him to seek specialized care at our clinic.

Upon evaluation, the patient denied any history of infectious diseases, smoking, or alcohol use. Vital signs were stable, with a blood pressure reading of 115/75 mmHg. Fasting plasma glucose was elevated at 9.8 mmol/L, indicating poor glycemic control. Given these findings, we recommended hospitalization to initiate structured treatment and prevent potential complications.

Treatment Approach and Clinical Management

After admission, a comprehensive panel of tests—including complete blood count, liver and kidney function panels, lipid profile, electrocardiogram, and arterial blood gas analysis—revealed no major abnormalities. Blood ketone levels were measured at 0.49 mmol/L, which falls within the normal range, ruling out diabetic ketoacidosis. However, further metabolic assessment showed a glycated hemoglobin (HbA1c) level of 9.5%, well above the target threshold, along with postprandial glucose readings reaching 13.75 mmol/L—confirming suboptimal long-term glucose management.

Intravenous Fluid Support and Glycemic Control

To address dehydration and restore electrolyte balance, an intravenous line was established, and the patient received 0.9% sodium chloride solution—a standard isotonic saline used to maintain extracellular fluid volume and support circulatory stability during acute metabolic shifts. This foundational step is especially important in patients with hyperglycemia, as high blood sugar can lead to osmotic diuresis and fluid loss.

Concurrently, short-acting insulin was administered subcutaneously to rapidly lower blood glucose levels. Once initial stabilization was achieved, the treatment plan transitioned to include dual oral therapy: extended-release metformin, which improves insulin sensitivity and reduces hepatic glucose production, and dapagliflozin, an SGLT2 inhibitor that promotes urinary glucose excretion. This combination approach targets multiple pathways involved in glucose metabolism, enhancing overall efficacy.

Positive Treatment Outcomes

Within days, the patient experienced a steady decline in blood glucose levels. Symptoms such as fatigue, excessive thirst, and frequent urination gradually subsided. No adverse reactions to medications were observed during the inpatient period. By day five, laboratory results confirmed that fasting and post-meal glucose values had returned to acceptable ranges, and the patient's general condition had markedly improved. With stable vitals and no ongoing complications, he met discharge criteria.

Before discharge, detailed instructions were provided regarding continued medication use, lifestyle modifications, and follow-up scheduling. The patient was advised to continue taking metformin and dapagliflozin as prescribed and to increase daily water intake to reduce the risk of urinary tract infections—a known consideration with SGLT2 inhibitors.

Ongoing Care and Preventive Guidance

While the immediate crisis was resolved, long-term success depends on consistent self-management. I emphasized the following key points during the discharge consultation:

• Medication Adherence: Patients must take their medications exactly as directed—even when feeling well—to maintain stable glucose control and prevent disease progression.
• Regular Monitoring: Routine check-ups should include HbA1c testing every 3–6 months and periodic fasting glucose assessments to track trends and adjust therapy if needed.
• Dietary Modifications: A balanced diet low in refined sugars, saturated fats, and sodium is essential. Emphasis should be placed on whole grains, lean proteins, vegetables, and adequate hydration.

Clinical Insights on Type 2 Diabetes Management

Type 2 diabetes is a chronic metabolic disorder characterized by insulin resistance and/or impaired insulin secretion. While its exact cause remains multifactorial—linked to genetic predisposition, obesity, sedentary lifestyle, and aging—early intervention plays a critical role in preventing microvascular and macrovascular complications.

This case underscores the importance of timely medical attention. Many individuals dismiss early warning signs like increased urination or unexplained weight loss, delaying diagnosis until more severe symptoms arise. In contrast, prompt recognition and integrated treatment—combining fluid resuscitation, insulin support, and modern oral agents—can lead to rapid stabilization and improved quality of life.

Moreover, therapies involving 0.9% sodium chloride solution are not merely supportive; they create the physiological foundation necessary for effective pharmacological action, particularly in dehydrated or metabolically stressed patients. When combined with evidence-based antidiabetic regimens, this approach offers a powerful strategy for managing acute presentations of type 2 diabetes.