Dear XXXXXXX,
Welcome to Health Care Magic

The ideal treatment is Insulin. Nowadays, there are syringes like pens with insulin cartridges making dose adjustments, measurements and injection easy, comfortable and least painful. There are insulin preparations in various permutation and combinations for tailoring the dose to the life style. The best option will be to continue insulin and adjust the dose.

If you still insist to change here are some suggestions –
•     Stricter Diet – you should see a Dietician / discuss on SEVERAL occasions / to get a good grasp of the subject – calorific values, glycemic index, exchanges and so on...
•     More Exercise – Regular and daily exercise
•     Keep your weight down / if possible below the normal range / – you did not mention height or Weight or BMI.

DRUGS:
     Take the drugs as INDIVIDUAL (separate) medicines till the control is achieved. Then you can switch to combination tablets.
     Keep Glimipiride (GP) at 2 mg. (Later / if necessary / it can be increased to 3 mg daily - by adding 1 mg in the evening / but not now / the maximum dose theoretically is 4 mg but practically it is limited to 3 mg only)
     Step up Metformin (Glycomet) to ONE gram twice daily. You may step up after a week – (to 3 grams, which is the maximum dose / one gram after each meal.)
     Add Voglibose 0.3 mg / with or immediately after each meal / that is 3 times in a day. It acts in the intestine to delay and reduce the absorption of sugar.

     There are a few more! However, before venturing into too many drugs, give the existing drugs reasonable time and dose.

     DO NOT DO ALL AT THE SAME TIME – one thing at a time. Introduce a new drug / or change the dose every 4-th or 5-th day
     BE AWARE OF HYPOGLYCAEMIA (low sugar) and HOW TO TACKLE IT. A family member should also know.
     SELF MONITORING OF GLUCOSE AT HOME is highly recommended. Buy a machine and learn to use it. Also teach some one else also - at home.

Your glycosylated haemoglobin level was extremely high (Hb A1C-19.1) – bad control over long term. Check in 2 months again
Your LDL is is slightly high (111) – it should ideally be 70 mg in diabetics / 100 is the limit. Start taking a statin (example - atorvastatin 20 mg)
Your Vitamin D is a bit low – nothing serious / Over the counter supplements are available.

Take care
Wishing speedy recovery
God bless
Good luck

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Hello

This tablet has Sitagliptin and Metformin.
The gliptins also stimulate your body's insulin (like GP but by a different mechanism / probably it is already under stimulated to limit...)
Instead of switching over to it - you step up your metformin - it acts by different mechanism.
Also you can add voglibose - again by another mechanism of action

Still Insulin is the best option

Regards
Good luck

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