Can I Have Medication Instead Of Insulin Injections For High Blood Sugar Levels?

Posted on Fri, 18 Sep 2015

Question: i was diagnosed having hbaic as 13.8 and fasting blood sugar 298. About a month back it was 5.3 and 260.
Doctor advised insulin 10 units in the morning and 6 units in the evening. Can I not get away with medicines instead of insulin straight.

Answered by Dr. Ajish TP (4 hours later)

Brief Answer:
It's better to start with insulin

Detailed Answer:
Hi,

Welcome to HCM. I have gone through your question and understand your concerns.

Your blood sugars are very high. If the HbA1C is more than 9%, it is always better to start on Insulin.

Reason: If your blood sugars are very high, that means your pancreas is not functioning and so oral medicines wont be useful. If you get started on insulin your pancreas will get rest and once sugars are brought down with insulin, the pancreas will start functioning again and you can then be started on oral medications.

Still if you are so much against insulin, you can be started on 2 or 3 anti diabetic medications and re assessed after a week. The usual initial medications I start in a similar patient will be Glimepiride + Metformin + Sitagliptin. If I don't adequate response in 1 month time I will add on insulin.

Hope I have answered your question. If you have ant further questions I will be happy to help you.

Regards,
Dr Ajish TP
Consultant Endocrinologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajish TP (1 hour later)

Thanks doctor.

My worry is once i start insulin, i was told it has to be used lifelong.

Another doctor told, without the PP reading, its not possible to prescribe medication and suggested a list of tests foot test, doppler foot test, lipid profile, ecg, bone density etc. Im confused. I have not visited Endocrinologist.

I want to get the tests redone for Fasting, Post lunch, hba1c tomorrow.

My questions are.

1. Is it a very serious and can damage other organs, if I delay the medication for two days ( atleast insulin) and will use the tablets.

2. Pl give the prescription for the above mentioned tablets so that i will from now on. Otherwise, if its required i will start the insulin. Pl suggest the number of units in the morning and evening.

3. Once I start Insulin, can i stop if glucose levels are under control.
I got the tests redone and levels are as follows:

FBS 217, earlier it was 298
PP now 350
HBA1c 13.4, earlier it was 13.8
Foot pressure test, blood flow doppler test, ECG, lipids,urine micral are all normal.
serum creatine is 1.36

Doctor suggested
1. glimestar M2
2. Neurokind

Review after 10 days.

Kindly suggest.

Awaiting your advise.

Thanks and regards,

XXXXXXX

Answered by Dr. Ajish TP (2 days later)

Brief Answer:
See detailed answer

Detailed Answer:
Hi,

Welcome back.

I understand your concern on starting insulins.

The answers to your questions are:

1. Diabetes will damage the organs due to prolonged high sugars. It won't damage within a day or two, it take years. So nothing wrong in waiting for two days

2. The prescription your doctor has suggested is ok - Glimistar M2 is metformin + Glimepiride combination. This is a good medication to start. If started on insulin, it can be either basal insulin (Glargine insulin) once daily 10 units daily or biphasic insulin ( Mixtard or Novomix) twice daily 10 units before breakfast and dinner

3. Once started on insulin you can decrease the insulin and stop it if sugars are controlled with oral medications.

Hope this will clear your queries

Regards
Dr Ajish TP

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar