Is HbA1c Value Of 7.2 A Cause For Concern?

Posted on Wed, 6 Jan 2016

Question: Sir,
My current weight is around 138 kg and HbA1c is 7.2

I am on following diabetic medicines:
1) Insulin:
Novorapid penfill 40-40-40 units
Levemir Flexpen 30-0-30 units
2) pills
Vidagliptine 50mg 1-0-1
Glimipiride 4 mg 0-1-0

I want to reduce cost of insulin. I want to change my diabetes medicine as follows:
1) Insulin:
Wosulin R penfill 40-40-40 units
Lantus penfill 0-0-42 units
2) pills
Vidagliptine 50mg 0-1-1
Glimipiride 4 mg 1-0-0
Pioglitazone 7.5 mg 1-1-1

Please advise. Thanks.

Answered by Dr. Dr. Abhay A Mali (1 hour later)

Brief Answer:
Insulin substitution may be acceptable.

Detailed Answer:
Hi Mr. XXXXXXX

Thanks for your question.
Noted your concern.

1) Regarding insulin substitution I may agree with your mentioned option.
That will definitely a cost saving option. But dose of lantus may need to be increased depending upon blood sugar levels.

2) Regarding addition of Pioglitazone to your current prescription.
I may not really in favor of adding pioglitazone as it may aggravate your problem of weight gain and oedema (as you have mentioned in your old questions). This problem increases especially with its use with such a high dose of insulin and sulfonyl urea (Glimipiride).
Though u can try that option after discussing with your treating diabetologist.

I may suggest use of Metformin 2000 to 2500mg per day in divided doses (if there is normal kidney and heart function).

There may be option of using new drug Teneligliptin instead of Vildagliptin for cost reduction.

You can discuss option of use of GLP1 agonist like Exenatide or Liraglutide that may really help in significantly reducing weight and insulin doses and use of other oral medicines, though cost may be the limiting factor.

Hope this helps you.

Regards,

Dr. Abhay Mali.
Diabetologist.

Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.

Above answer was peer-reviewed by : Dr. Arnab Banerjee