Brief Answer:
You need blood sugar monitoring and adjustment of doses of medicine.

Detailed Answer:
Hi Mr. XXXX,

Thanks for your question.

After going through your question, I can understand your concern.

At present you are on four different oral antidiabetic medicines on near maximal dose (Triopil 2 contains Metformin 500mg + Glimepiride 2mg + Pioglitazone 15mg and Glucobay contains Acarbose 50 mg) along with insulin Mixtard (combination of short acting and intermediate acting insulin) and still your blood sugars are above 300.

I would like to advise you -
1) Blood tests
- HbA1c
- Renal function test.
- Liver function test.
2) EKG if required 2DEcho of heart.
3) Strict diet control and regular exercise.
4) Monitor blood sugar at home by using glucometer (SMBG- Self Monitoring of Blood Glucose) as follow-
- Fasting (Before breakfast)
- 2 Hours after breakfast.
- Before lunch.
- 2 hours after lunch.
- Before Dinner.
- 2 hours after dinner.
- Early morning 3am.
It is usually advisable to do as much as readings possible from all of above readings daily.
Otherwise at least 2 or 3 reading should be done daily.
If required additional readings should be done in case there are symptoms of low blood sugar (hypoglycaemia), in that case you should also notice date and time of incidence any change in meal pattern, increased physical activity on that particular day.

5) Confirm your insulin taking technique from your doctor.
6) Check your height, weight & BMI.

Depending upon your BMI (Body mass index), kidney and heart function, blood test results and Weekly SMBG chart appropriate changes in doses of insulin can be done with our without changes in oral anti-diabetic medicines.

If one of my patient may have come to me with similar scenario with normal heart, liver and kidney function, I would have advised him -
Maximal dose of metformin (2 gram per day) with acarbose (Glucobay) 50 mg twice a day with long acting (basal) insulin like glargine once a day and injectable GLP 1 receptor agonist like Liraglutide once a day with SMBG charting and accordingly other oral antidiabetic medicines would have been added.

You should discuss your issues with your treating doctor.

Hope I have answered your question.
I will be happy to answer your follow up questions if any.
Otherwise you can close the question and rate the answer.

Regards,
Dr. Abhay Mali.
Diabetologist.

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Brief Answer:
Thanks.

Detailed Answer:
Thank you sir,
I will be happy to answer your follow up question.

Regards,
Dr. Abhay Mali.
Diabetologist.

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