Are the HbA1C tests taken last month reliable for recommending treatment for my diabetic husband?

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I have seen the reports (attachment removed to protect the patient's identity) and doctor's prescriptions. May I know what earlier drugs were taken before this prescription was given? Because his diabetes was reasonably well controlled, as seen from the report from two months back. I do not see any reason to change earlier drugs. Another important aspect is his being obese, with a BMI of 33.1 kgs. He has to cut down the weight by over 20 plus kgs. It means there is a need to reduce food intake. It should be based on his ideal body weight (63 kgs), not his current weight. That means he needs to change his routine and has to spend time for exercise for over an hour a day. There is no shortcut. Even his food intake of two chapatis per meal has to come down to one chapati, and he has to increase the intake of green leafy vegetables and salads with each meal. I will provide a general guideline of diet he may consider following. But first, let me know what the earlier drugs were. Tablet B 29 LC ( Folic acid, Levocarnitine, L- Tartrate, Mecobalamin, and Vitamin D3) seems too expensive and unnecessary. There are good options which I will suggest. As regards repeat investigations, HbA1C will hardly change in a short time as it reflects the previous three-plus month's situation. When one visits a consultant, asking for all the investigations to be repeated is a practice. If you want my opinion, then there is no need at all. There will be a significant reduction in glucose levels if weight is reduced. Probably he may even need just minimal medications. But he has to take it very seriously.

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With the drugs prescribed (attachment removed protect the patient's identity), his glucose was well controlled; hence I do not see any reason for changing the medications to costlier ones. If he has already started the treatment with newer drugs, it may be continued, or continuing the earlier one is better. Plus, consider diet changes and increased physical activity because weight control will give him a tremendous advantage in controlling blood glucose levels. Hence no reason to shift to Dapagliflozin (Dapagliflozin propanediol monohydrate) combination. I hope what I have said is clear. If you have any doubts, please do revert. The earlier treatment gave excellent results, so there is no reason to change. Thank you.

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Post-prandial (PP) blood glucose reflects that particular day's level based on what was eaten earlier. It can vary depending on the intake; that is, it can be low or high based on the food intake. At the same time, HbA1C is the amount of glucose attached to hemoglobin in RBCs (red blood cells). This reflects the average glucose level. It is not immediately reflected based on a particular day's high or low post-prandial or fasting glucose. Since RBCs have a life span of 110 days, the HbA1C tells us about how overall glucose control has been there over the previous three-plus months. However, an excessive increase in PP glucose levels daily can influence HbA1C in the next reading (taken after three to four months). I hope it is clear. Therefore apart from having a good HbA1C, it is equally essential to maintain both fasting and PP levels within the recommended levels so that long-term complications associated with diabetes either are postponed or prevented. As regards, I will send you a diet chart, a guideline for 1200 calories diet plan, which can help in planning your diet. It may take a day or so for that. Here I am giving a diet chart for 1200 calories, and I suggest you follow it. Early morning drink warm water with a dash of lemon. Morning tea without sugar with skimmed milk. One or two biscuits (91 calories). For breakfast, take two sprouts dosas with a cup of tomato onion chutney (calories 220) or an omelet of two egg whites and two slices of brown bread (250 calories). Mid-morning, have a bowl of fresh fruits and a cup of green tea (40 calories). For lunch, mixed vegetables salad (cucumber, cabbage, capsicum. tomato, palak, onion, and carrot), onion raita, brown rice (one third of soup bowl equals to 305 calories or two phulkas, one cup ladies finger vegetable, sprouted green gram sundal 353 calories). Evening snacks include green tea, coffee without sugar, and sprouted green gram sundal (105 calories). Dinner must consist of khichadi, raita, one medium-sized bowl, and vegetable salad (335 calories). At bedtime, you can have a cup of milk with four soaked almonds (95 calories). This a guideline; it should help in planning your meal. Please make sincere efforts to cut weight; that will go a long way in achieving better glucose control. Thank you.

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Welcome back to icliniq.com.

It is good to know that a sincere effort will be made. All the best. Thank you.