I am sending a few doubts of my relative, who is suffering from diabetes and HTN. They have a strong case history of CKD in the family. For diabetes, the patient was taking the following medicines. A combination of Metformin 850 mg and Glimperide 1 mg in the morning and a combination of Metformin 850 mg and Glimperide 2 mg at night. His sugar was not under control, and he went to a doctor, who changed all his medicines, and later on, he tapers down the medication.
After taking the above medicines, he found his RBS as 297 mg/dL, and he went to this new doctor and prescribed him Tiban 20/500 mg twice a day and Crano-D once a day (This is a combination of Manrose 600 mg and Cranberry extraction 300 mg). He measured sugar in regular intervals, and his sugar was coming down.
Now he has an RBS of 100 mg/dL, and the doctor gave him Tiban 20/500 mg once a day and Crano D once a day. Now he doubts that whether he has been given heavy doses of medicines. Is the present given drugs have equal strength compared to his previous medications? Since they have a family history of CKD, they approached me to determine whether they are on the right track or misled by prescribing high doses first and then reducing slowly. Please guide, sir.
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Hi Sir, First, I wanted to be clear.
1. Is he still taking Glimepiride and Metformin?
2. Tiban is Teneligliptin, which I do not prescribe much. But it is safe to take 20 mg twice daily. Also, it is safe to take once daily in a person with kidney problems.
3. Metformin can be given up to 3000 mg daily. Assuming he also took Glimepiride and Metformin. The total dose is only 2650 mg which is the maximum dose I use, as long as the kidneys are fine.
4. Crano-D is used for recurrent urinary infections, but not sure if it is helpful or not. So, I do not know if your relative needs it.
5. If your relative has normal kidney function now (with normal creatinine), there is no risk of high doses. I assume he has a strong CKD family history, but he does not have any kidney issues now. Overall, I think there are no issues here, and he can continue the medicines. As usual, make sure he checks HbA1c (glycated hemoglobin) once in three months and creatinine and urine albumin creatinine ratio once a year.
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