Brief Answer:
Pioglitazone is a effective antidiabetic. In a dose of 7.5 it is safe.

Detailed Answer:
Hi Mr. XXXXXXX

Thanks for your question noted your concern.
Pioglitazone is a very effective antidiabetic drug.
It may be associated with water retention and weight gain especially in patients with kidney and heart problem.
In recent studies it is found to be associated with fracture of long bone this is more prevalent in postmenopausal females.
With a dose of 7.5 mg per day chances of these side effects are very less.

In such a case I may suggest Detailed physical examination and following investigations-
- HbA1C.
- Renal function test- urea, creatinine, electrolytes.
- Liver function Test.
- Urine examination.
- Lipid profile.
- ECG & If required 2DECho of heart.

Depending upon above I may suggest-
- Metformin starting with low dose with gradual increase in dose to 1000mg to 1500mg per day over a period of 8 to 10 days.
- If there is no significant weight gain or there are no kidney or heart issues Pioz 7.5mg may be continued.
- May increase the dose of Galvus 50mg twice a day.
- May stop or decrease dose of Diamicron xr depending upon HbA1c and current Fasting and post-prandial blood sugar levels.

Along with all above diabetic diet and regular exercise is important.

It is better to consult near by diabetologist for detailed evaluation.

Regards,
Dr. Abhay Mali
Diabetologsit.

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Brief Answer:
You need psychological counselling.

Detailed Answer:
Diabetes is almost a life long disease and as duration of diabetes and age advances there is a need to increase medicines almost in every patient.

One should understand side effects of uncontrolled blood sugar levels are much more serious than minor side effects of medicines.

Depending upon your current fasting, post-prandial, HbA1c level and detailed physical examination appropriate medicines can be suggested.

For a diabetes of 10 years it is unlikely to be controlled with only one medicine. One has to use combination of different medicines to control blood sugar levels.

I am not aware of ayurvedic or any substitute treatment.
But I may suggest one can definitely use alternative treatment under guidance of expert along with allopathic medicines with close monitoring of blood sugar level. Depending upon blood sugar levels one can reduces or may completely stop allopathic treatment but this should be done strictly on the basis of regular blood sugar and HbA1c testing.

Diabetes is not so complicated as you are perceiving. You need one to one detailed psychological counselling which can not be possible on this platform.
You should consult near by diabetologist for same.

I may suggest 1800 Kcal Diabetic, Salt restricted (Considering BMI of less than 25).

- Avoid sugar, food containing empty calories (food containing only calories and no other nutrients like soft drinks).
- Avoid potatoes.
- Can eat citrus fruits like orange, sweet lemon or other fruits like 1 cup pieces of papaya, pineapple, water melon, apple daily.
- Avoid fruit juices.
- Take adequate amount of salad containing tomatoes, cucumber, green leafy vegetables daily.
- Use green leafy vegetables in soup or salad.
- Use sprouts in various forms like in salads, curry.
- Can use artificial sweeteners up to certain extent.
- Restrict fat (all types of oil, butter, ghee) intake to less than 20 to 25 gram per day.
- Use combination of different types of vegetable oils.
- Avoid intake of saturated fat like coconut oil, pam oil, vanaspati ghee, regular butter.
- Take adequate amount of pulses, soybean.
- Can take 1 cup of Cow milk without cream daily.
- Can take daily one egg white (no yellow bulk).
- Can have Fish once or twice a week, 2 to 3 piece of chicken once in a week avoid red meat like lamb.
- Restrict rise intake to minimum.

Meal planning:
I may suggest
- To take small amount of meals frequently.
Morning breakfast in between 7am to 9am.
1 Cup Tea of cow milk without sugar or Milk with 2 to 3 XXXXXXX biscuits.
1 Small plate Poha / XXXXXXX / Idalis (2) or Dosa / Vegetable Paratha without
butter or ghee.

Mid morning snack containing fruits as suggested at around 11 am.

Lunch in between 12.30 to 1.30 pm.
2 to 2 & Half Chapaties, Green leafy vegetables, Pulses in any form like 1
small bowl Dal, Sprouts, Salad. Can take Half bowl rice in lunch.

Evening snack at around 5 pm.
Same as morning breakfast or can have diet Khakra, oats.

Dinner in between 8 pm to 9.30 pm.
Same as Lunch but rise should be avoided.

1/2 to 1 cup of milk at bed time.

Occasional use of 1 to 2 pegs of alcohol in any form may be permitted.

Everyone has his own likes and dislikes and food pattern.
It is always better to consult near by dietitian who can plan diet for a person depending upon Body Mass Index and his likes and dislikes and staple food pattern.

Hope this helps you.

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Brief Answer:
Thanks.

Detailed Answer:
All the best.

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