I am 62 with HbA1c 8.2. What meds can I try before insulin?

Question

Hello doctor,

I am a 62-year-old male diagnosed with type 2 diabetes five years ago. I have been on Metformin and recently started Glimepiride because my HbA1c went up to 8.2 percent. I also have high blood pressure and mild diabetic retinopathy.

Despite following my medication schedule, I struggle with sticking to a healthy diet and regular exercise. My feet have started feeling numb at times, and I am worried about diabetic neuropathy.

My doctor mentioned possibly starting insulin if my sugars remain uncontrolled, but I am nervous about injections. Please suggest to me.

Are there other medication options before insulin?
What can I do to prevent further complications like kidney disease or worsening eye problems?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Type 2 diabetes is a progressive condition, and when your blood sugar remains above target despite oral medications like Metformin (an anti diabetic drug) and Glimepiride (a sulfonylurea class drug for diabetes), you need to add another drug class before starting insulin.

There are some Options like DPP-4 (dipeptidyl peptidase 4) inhibitors, SGLT2 (sodium-glucose transport protein 2) inhibitors, and GLP-1 (glucagon-like peptide-1) receptor agonists, some of which can help with weight control and offer heart and kidney protection, though their suitability depends on your overall health and cost considerations.

The numbness in your feet is an early sign of diabetic neuropathy, so maintaining good blood sugar control is crucial to slow its progression. To prevent further complications such as kidney disease and worsening retinopathy, it is important for you to aim for an HbA1c near your target, keep your blood pressure well controlled, and manage cholesterol.

Lifestyle changes are important in diabetes care. Adopting a diet rich in vegetables, lean proteins, whole grains, and limited processed sugars, while moderating portion sizes, can make a significant difference in your life. Regular physical activity, even walking 30 minutes most days, helps improve insulin sensitivity and circulation.

You should also have annual comprehensive eye exams, kidney function tests, and foot checks to detect problems early. If insulin ever becomes necessary, know that it can be started gradually and with very fine needles, making injections less intimidating, but with consistent effort on medication, diet, and exercise, you may still be able to avoid or delay its use.

I hope this information helps you.

Feel free to ask further queries.

Thank you.