Can diabetes meds be stopped if HbA1c is now 5.6?

Question

Hi doctor,

This is concerning the health condition of my wife. She was diagnosed with type-2 diabetes with HbA1c of 10% three months back and was prescribed Vildagliptin and Canagliflozin. We consulted a dietitian as well and went on an exercise regimen with full diet control. Took the HbA1c results yesterday and was found to be 5.6 with CBC-hemoglobin-13.2 mg/dL. Her doctor was surprised and could not able to believe. He changed the medication to Metformin 500 mg and retained Invokana and told us to take it for the next three months. Please advise us whether to go on with the tablets, as we heard that for this level of HbA1c, tablets are not required. We want to fight it with diet and exercise. We want to switch to Ayurveda. So, is this the right time? The doctor advised that we should be administered Insulin if we are planning for pregnancy. We are planning for the next year, though. Please advise whether we have to compulsorily use Insulin? Is there no other alternative? Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Since there was a sudden fall in HbA1c level, your doctor might have been surprised by the change. He might want to follow up for a couple of weeks or a month to ascertain that everything is going well. That is probably why your wife is now on Melmet 500 (Metformin), which is the first-line drug for diabetes. If her blood glucose levels are stable with diet and exercise, then she will be able to go off medication. But that needs to be confirmed by the doctor after subsequent testing. Her HbA1C came down to 5.6 while she was on earlier medication. Now the doctor has reduced the dosage to a minimum, and your wife's reports will be followed up for further progress.

Depending on the next report, your doctor will take further action. That is how it usually works. So, do not be in a hurry to stop medication, and do not make any hasty decisions. Regarding the efficiency of Ayurvedic medicine, there have been reports of effective medicines in Ayurveda, but this needs to be discussed with an Ayurveda expert. Be sure that you are consulting a doctor who practices pure Ayurveda and prescribes genuine medicines. You may be aware - all that is labeled herbal may not be Ayurvedic.

Regarding pregnancy, I think what your doctor meant is that when your wife gets pregnant, if her blood sugar is not under control, she will have to take Insulin. It is true because oral medications are not recommended in pregnancy. Insulin is the safest medicine for use in pregnancy. In case her blood sugar is normal during pregnancy (without any medication), she may not need Insulin or any other medication. However, she will still need to be tested regularly to be sure that she is in the normal range. You do not have to be apprehensive about Insulin use; there are a lot of myths associated with Insulin use. It is a safe drug, easy to manage, and after pregnancy and lactation, she can slowly move to oral medication again. Since you have another year to plan the pregnancy, she can now focus on lifestyle modification, a balanced diet, and exercise, and make a decision based on how things unfold. Stay positive, stay healthy.

I hope this helps you.

Thank you.