Brief Answer:
Changes in medicines need to be considered.

Detailed Answer:
Hi,

Thanks for your question.

Noted your concern.

First it is important to know contents of medicines-
- Tab Galvus Met (50/500) contains Vildagliptin 50mg and Metformin 500mg
- Tab Dimicron XR 60 contains Gliclazide 60mg.

Vildagliptin and Metformin usually do not cause hypoglycemia (low blood sugar level) when used alone or in combination with each other.

Possibility of hypoglycemia with use of Gliclazide (even when used alone) is much more than metformin and vildagliptin, this risk further increases with use of Tab Galvus Met.

In such situation I may have advised -
- To stop all oral antidiabetic medications for time being.
- ToCheck Blood sugar levels every 4 hourly and during symptoms of hypoglycemia with home glucometer.
- To Use complex carbohydrates to prevent hypoglycemia and glucose water during episode of hypoglycemia.
- To do following Investigations
. Complete blood count.
. Renal Function Test- Urea, creatinine, electrolytes, uric acid.
. Liver Function Test.
. Urinary albumin creatinine ratio.
. HbA1c
. Lipid profile
. T3, T4, TSH

Deranged liver and kidney function may associated with delayed clearance of medicine from body which leads to hypoglycemia.

Depending upon detailed clinical examination, blood sugar chart and above test results decision regarding restarting of Tab Galvus Met or use of different antidiabetic medicines considering Renal and Liver function test (if deranged) can be taken.

Hope this helps your Mrs.
I will be happy to answer your follow up questions if any.

Regards,
Dr. Abhay Mali.
Diabetologist.

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Brief Answer:
She requires further evaluation.

Detailed Answer:
There may be following causes for increased risk of hypoglycemia-
- Dibetic nephropathy.
- Skipping meals or inadequate food intake despite of taking antidiabetic medicines.
- Acute illnesses.

There is a need to evaluate for diabetic nephropathy.
Risk of diabetic nephropathy increases with-
. Duration of diabetes
. Control of diabetes.
. Associated conditions like high blood pressure.
. Cholesterol problem

As stage of nephropathy advances risk of hypoglycemia (even with use of same medicines which patient used to take before) increases.
This is because decreased clearance of drug from body.

I may advise -
- Continue taking Tab Galvus Met (50+500) as before twice a day, as risk of hypoglycemia with its use is less.
- Stop taking Tab Dimicron XR
- Check blood sugar level 4 to 6 hourly and whenever there are symptoms of hypoglycemia.
- Use complex carbohydrates to prevent hypoglycemia and glucose water during episode of hypoglycemia.
- Get above investigations done as advised before.

Depending upon test results and blood sugar levels appropriate decision can be taken.

Also there is need of regular screening for diabetic complications like diabetic nephropathy, neuropathy, retinopathy.

You should consult your endocrinologist/ diabetologist for better opinion as clinical examination and detailed history taking is important.

Hope this helps you in making appropriate decision.
I will be happy to answer your follow up queries if any.

Regards,
Dr. Abhay Mali
Dibaetologist.

In future you can directly ask questions to me on following link-
http://www.HealthcareMagic.com/doctors/dr-abhay-a-mali/69954

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