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Suggest Remedy For Uncontrollable Blood Sugar Levels
Question: Hello doctor, my husband is having diabetes for the more than 15 years now. His fasting sugar level does not go below 150 now despite having medicine twice daily (Gluconorm-G 4 forte). till january he was having Janumet 50 500 twice daily. But the drug was changed after a general health cheak up because of high sugar level (200 fasting and 350 pp) . Still the sugar level have not improved. he is also diagnosed with kidney stones(one is of 10 mm) and fatty liver grade II. he used to go for morning walk but his orthopaedic sirgeon adviced him to stop that for having on set of Arthritis. Please advice him .
Brief Answer:
After trial of modified oral medications Insulin treatment is better choice
Detailed Answer:
Hi,
Thanks for your question.
Noted your concern.
Your husband has long term diabetes more than 15 years.
First one need to know natural history of Type 2 diabetes.
It has 2 elements
1) Insulin resistance : Increased need of insulin by body.
2) Pancreatic dysfunction: Failure of pancreas to release extra insulin as per body's requirement.
With medications, exercise and diet modification there may be some reduction in insulin resistance which more or less remains constant over period of time.
But as duration of diabetes and age of patient advances there is progressive increase in pancreatic dysfunction.
Therefore as duration of diabetes advances there may be a need to increase dose of medications or increase the number of medications to control blood sugar levels.
Tab Gluconorm G4 forte contain Glimepiride 4mg and Metformin 1000mg.
Tab Janumet contains Sitaglitin 50mg and Metformin 500mg.
In such scenario I may have suggested-
- To do HbA1c.
- To continue Tab Janumet twice a day.
- Tab Gluconorm G1 (Glimepiride 1mg and Metformin 500mg) twice a day.
And may have rechecked fasting and post-prandial blood sugar level after 2 to 3 weeks and if blood sugar levels are not within limit at time I may suggest long acting insulin (glargine) at bed time.
Along with this I may suggest-
- Regular blood pressure monitoring.
- Lipid profile and Statins (Cholesterol lowering medicines).
- Screening of diabetic complications like
+ Diabetic foot examination.
+ Fundoscopy to know diabetic retinopathy.
+ Renal function test and urine albumin creatinine ratio for nephropathy.
- Exercise especially yoga which are safe in arthritis after consultation with orthopedician and local physiotherapist.
- Diet modifications: You should consult near by dietician who can plan diet for your husband considering his BMI (Body Mass Index), food habits.
Fatty liver may be due to insulin resistance treatment for diabetes with control of blood sugar level and lipids may help.
For renal stone consult urologist.
Hope this helps you.
Regards,
Dr. Abhay Mali.
Diabetoloist.
After trial of modified oral medications Insulin treatment is better choice
Detailed Answer:
Hi,
Thanks for your question.
Noted your concern.
Your husband has long term diabetes more than 15 years.
First one need to know natural history of Type 2 diabetes.
It has 2 elements
1) Insulin resistance : Increased need of insulin by body.
2) Pancreatic dysfunction: Failure of pancreas to release extra insulin as per body's requirement.
With medications, exercise and diet modification there may be some reduction in insulin resistance which more or less remains constant over period of time.
But as duration of diabetes and age of patient advances there is progressive increase in pancreatic dysfunction.
Therefore as duration of diabetes advances there may be a need to increase dose of medications or increase the number of medications to control blood sugar levels.
Tab Gluconorm G4 forte contain Glimepiride 4mg and Metformin 1000mg.
Tab Janumet contains Sitaglitin 50mg and Metformin 500mg.
In such scenario I may have suggested-
- To do HbA1c.
- To continue Tab Janumet twice a day.
- Tab Gluconorm G1 (Glimepiride 1mg and Metformin 500mg) twice a day.
And may have rechecked fasting and post-prandial blood sugar level after 2 to 3 weeks and if blood sugar levels are not within limit at time I may suggest long acting insulin (glargine) at bed time.
Along with this I may suggest-
- Regular blood pressure monitoring.
- Lipid profile and Statins (Cholesterol lowering medicines).
- Screening of diabetic complications like
+ Diabetic foot examination.
+ Fundoscopy to know diabetic retinopathy.
+ Renal function test and urine albumin creatinine ratio for nephropathy.
- Exercise especially yoga which are safe in arthritis after consultation with orthopedician and local physiotherapist.
- Diet modifications: You should consult near by dietician who can plan diet for your husband considering his BMI (Body Mass Index), food habits.
Fatty liver may be due to insulin resistance treatment for diabetes with control of blood sugar level and lipids may help.
For renal stone consult urologist.
Hope this helps you.
Regards,
Dr. Abhay Mali.
Diabetoloist.
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Deepak
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