I have T2D with high FBS. Should I consider other drugs?

Hello,

Welcome to icliniq.com.

I understand your concern.

I have read your concern, and you are doing well, like you said. You have been on Metformin for three months, your fasting glucose is 140 mg/dL, and you are following a diet and walking daily.

Based on your description, you might probably have insulin resistance. And to assess your condition, you need to get a few investigations, such as:

1. HbA1c (glycated hemoglobin).

2. Urine analysis.

3. Urine microalbumin.

4. Lipid profile.

5. Serum creatinine.

6. Fasting blood sugar.

To answer your questions, below is a clear explanation to see meaningful improvement in your glucose levels:

With Metformin, you need to take it for six to 12 weeks for it to work effectively. Benefits from diet and exercise will usually appear in four to 12 weeks, but the significant change will appear after three to six months as weight, muscle mass, and insulin sensitivity improve.

If fasting glucose is more than 130 mg/dL after three to four months of consistent treatment and lifestyle changes, it is time to consider intensifying therapy.

Doctors usually add a second medication when there is no significant change in your blood glucose levels, even after three months of maximum tolerated Metformin, and your HbA1c is still above target (usually above 7%).

Your fasting glucose of 140 mg/dL likely means your HbA1c is around 6.8 to 7.3 %, but that should be confirmed with a blood test.

The second drug choice depends on your health and fitness. They will check your heart and kidney status, weight goals, risk of hypoglycemia, and cost or insurance. A few things to consider before adding newer drug classes are:

GLP-1 receptor agonists (for example, Semaglutide, Dulaglutide, Liraglutide)

• It can be used for strong HbA1c reduction, weight loss, and reduced heart or kidney risk in high-risk patients.

• It is injectable (most) form, GI (gastrointestinal) side effects, and expensive.

• It is safe in overweight, at cardiovascular risk, or needing potent glucose-lowering.

SGLT2 inhibitors (for example, Empagliflozin, Dapagliflozin)

• It helps in moderate HbA1c drop, modest weight loss, lower BP (blood pressure), and heart and kidney protection.

• Risks include genital yeast infections and dehydration.

• It is safe in Cardiovascular disease, kidney disease, or heart failure risk.

Here are a few early signs of possible organ damage to watch for.

1. Foamy urine (protein), ankle swelling, and usually picked up first by urine microalbumin tests, show that your kidneys are not functioning properly.

2. When the eyes are affected, blurred vision and floaters occur, but early retinopathy is symptomless.

3. Tingling, numbness, or burning in the feet or hands indicates nerve involvement.

4. Unusual shortness of breath, chest discomfort on exertion, and fatigue may be suggestive of heart issues.

Unfortunately, organ damage from high blood sugar is often silent in early stages, which is why regular screening is key. So, you need to undergo a few routine tests, such as:

1. HbA1c every three to six months.

2. Urine microalbumin and kidney function test.

3. Dilated eye exam.

4. Foot exam.

5. Blood pressure and cholesterol.

You can continue taking Metformin 1 gram after breakfast and dinner. Do follow up after 16 days with your reports. Avoid deep-fried meals and juices.

I hope this helps.