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Suggest Alternative Medication For Elevated HbA1C Levels

Posted on Fri, 17 Jun 2016

Question: a. I have done test for Diabetes. Following are the results:
Plasma Glucose (Fasting): 83
Plasma Glucose (PP): 93

HbA1C by HPLC: 6.0

Question:
a. As understand HbA1C > 5.4 has high risk of diabetes/pre-diabetes. Is it correct? I consulted a physician and she prescribed Glycomet 250 mg after lunch and dinner. However after few days, I started to have side effects (stomach upset/diarrhea).

Should I be on medicine for higher HbA1C? If yes, then is there any alternative medicine which can be tried?

b. I have been having Cholesterol. I am taking Rosave 10 mg every night. Recent lipid profile results have come normal.

b. I am following healthy lifestyle (healthy food + regular exercise for about 45 minutes). However I am unable to reduce my weight. My weight is 93 KG (5.8", 44 years). Do you have any recommendation for controlling/reducing weight?

Regards,
XXXXXXX XXXXXXX

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

Brief Answer:
May suggest to continue Glycomet & Rosave.

Detailed Answer:
Hi Mr. XXXXXXX XXXXXXX

Thanks for your question.
Noted your concern.

Answer to your questions one by one-
a) Yes HbA1c of >5.4 has high risk of progression to pre-diabetes or diabetes.
HbA1c of 6.0 denote pre-diabetes.
There are increased risk of progression to diabetes from pre-diabetes if
- There is family history of Type 2 diabetes.
- Obesity as in your case (Your BMI is 32.17).
- Sedentary life style (Physical inactivity).

I may suggest to continue Tab Glycomet (contains Metformin) as advised by your doctor.
Stomach upset caused by Metformin is usually short lasting body get adopted to it.
For Pre-Diabetes metformin is a only approved drug.

b) Considering your BMI & Pre-diabetic status I may suggest to continue use of Rosuvastatin (Rosave) irrespective of lipid level.

c) For weight reduction body should be deprived of calories (calorie restricted diet) with utilization of stored calories (exercise).
This process should be gradual considering your effort tolerance with close follow up with your diabetologist and dietitian.

Hope this helps you.

Regards,
Dr. Abhay Mali.
Diabetologist.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Abhay A Mali (37 minutes later)

Thanks for the reply.

c) For weight reduction body should be deprived of calories (calorie restricted diet) with utilization of stored calories (exercise).
This process should be gradual considering your effort tolerance with close follow up with your diabetologist and dietitian.

I have been following diet suggested by dietitians. Many different combinations for have been tried. However weight is not reducing. As I mentioned, I have been doing regular exercise.

I am concerned as I am not able to find any reason why weight is not reducing.

Let me know if you have suggestion for balanced diet. I am a vegetarian and mostly eat home made food.

Is there any medicine which can help in reducing/stopping fat deposition? My doctor had prescribed me Xenical 120 mg. Unfortunately the production of the said medicine has stopped. Any alternative medicine you can suggest?

Regards,
XXXXXXX XXXXXXX

Answered by Dr. Dr. Abhay A Mali (13 hours later)

Brief Answer:
Calorie restricted diet.

Detailed Answer:
I may suggest 1200 to 1600 kcal with 70 to 80 gram of protein depending upon your tolerance.
At present there is no alternative drug available for orlistat (Content of Xenical).

Better to discuss this issue with your diabetologist & nutritionist.

Hope this helps you.

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

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