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Suggest Treatment For Type 2 Diabetes

Posted on Tue, 27 Oct 2015

Question: Hi Dr. My wife is 47 and has type2 diabetes for the last 10 years. She is on novomix insuline @12 units twice a day, amaryl 2 mg twice and gluformin 500 once before bed. Her recent blood sugar readings came very high fasting:185; pp 285 and H1BAC 9.3. She is a vegetarian and has not been able to any exercises as she has pains in both knees and calf muscles. Her LFT, KFT and cholesterol normal but vitamin D is low 49. Please suggest what she shoulddo for getting blood sugar under immediate control.

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

Brief Answer:
Needs frequent blood glucose monitoring with modification medicines.

Detailed Answer:
Hi,

Thanks for your question.

Noted your query.

There are many options that can be considered for better blood glucose control in your wife's case.

If one of my patient comes to me with similar scenario, I would have suggested-

* Calories and fat restricted diet.

* Though there is restriction to exercise because of knee and calf muscle pain, one can try yoga.

* Medications:
- I would have omitted Tab Amaryl & Gluformin and started on Tab Containing Sitagliptin 50 mg + Metformin 500 mg twice a day.
- Along with this it may be advisable to take Novomix-30 twice a day Before Breakfast and Before Dinner dose of insulin need to be modified with frequent blood glucose monitoring with Glucometer.
- Blood glucose monitoring-
In such case I would have advised SMBG (Self Monitoring of Blood Glucose) using home glucometer.
Following blood glucose need to be monitored
Fasting
2 Hours after breakfast.
Before lunch.
2 Hours after lunch.
Before Dinner.
2 Hours after Dinner.
3 am occasionally.
At least 2 different readings per day.
Accordingly dose of Novomix can be changed.

* Along with this would have continued Tab Cardace 2.5, Tab Shelcal 500 and Calcirol as before.

* Advisable to monitor-
- Lipid Profile.
- Urine albumin creatinine ratio.
- Fundoscopy to see the changes diabetic retinopathy.

I would have started Statin (Cholesterol lowering medicine) dose of which depends on Lipid profile.

It will be better for her to consult her treating Diabetologist for appropriate changes in medicines considering her clinical evaluation and reports.

Hope this helps her.

Regards,
Dr. Abhay Mali.

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Dr. Abhay A Mali (7 hours later)

Thanks you doctor. Just wanted to ask when to take Sitagliptin 50 mg + Metformin 500 mg after breakfast/After dinner?

Answered by Dr. Dr. Abhay A Mali (9 minutes later)

Brief Answer:
After breakfast & after dinner.

Detailed Answer:
Thanks.

I would have advised to take Tablet containing Sitagliptin 50mg + Metformin 500mg twice a day after immediately breakfast and immediately after dinner.

Hope I have answered your query.
You can close the discussion and rate the answer.

Regards,
Dr. Abhay Mali

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. Abhay A Mali (31 minutes later)

one last question Sir. Her Vitamin D levels are very low it is about 49. Will it have impact on Diabetes?.What medication should she take for this. Doctors prescribed calcirol XXXXXXX once a week for 6 weeks and another doctor suggested Diacerin 50 for leg pains?
Kindly advice

Answered by Dr. Dr. Abhay A Mali (25 minutes later)

Brief Answer:
Her Vitamin D level is adequate.

Detailed Answer:
Her Vitamin D level is sufficient. (< 10 is deficient, 10 to 30 is insufficient and > 30 is sufficient).
This much level did not have bad impact on diabetes.
Though I would have suggested to continue to continue Calcitriol as advised.

Diacerin is for pain suppression in osteoarthritis, she can take it as advised by her doctor.

Hope this helps her.

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

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj