Dr. Prabhakar Laxman Jathar
Diabetology
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Patient's Query
Hello doctor,
I have diabetes since last 15 years and is poorly controlled. I have been taking Glimepiride 1 mg, 500 mg Metformin, daily, once in a day (in the morning). Average fasting glucose level is above 170 mg/dl daily and after the meal is usually 350+ mg/dl. HbA1c is 10. Please review my medication. Suggest an increase for good diabetes control. I am a 57 year old male with a weight of 165 pounds, a little daily exercise (1 km brisk walk in the morning and same in the evening). I eat one loaf in the morning and two in the evening and no snacks in a day. No ketoacidosis as no fruity smell in breath and urine. Please help.
Hello,
Welcome to icliniq.com.
I have seen the details (attachment removed to protect patient identity). Your blood glucose is definitely very poorly controlled. Even BP is also high. Ideally fasting glucose should be less than 100 mg, PP 150 to 170 mg and HbA1c % less than 6.8, in a well-controlled diabetic person. It is clear that present medications are not giving effective control. Following is my suggestion for improving the treatment. There is a need to increase the dosage of Glimepiride to 2 mg with Metformin 500, (to be taken twice a day). To add tablet Vildagliptin 50 mg with 500 mg Metformin to be taken after lunch. Then please check blood glucose (fasting and PP ) after 10 days and report. Increase the intake of green leafy vegetables and salads before taking every meal. Increase the exercise to over one hour a day. If brisk walking is done please increase it to one hour (about 4 to 5 km). For blood pressure, increase Amlodipine to 5 mg per day. Get a lipid profile done and report the same.
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Diabetology
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