I have uncontrolled diabetes. How to monitor complications?

Question

Hello doctor,

I am 46 and have had type 2 diabetes for four years. My recent HbA1c was 8.1 %, and fasting sugar was 165 mg/dL. I am on Metformin 1000 mg twice daily, but readings are still high.

Should I consider starting an SGLT2 inhibitor or GLP1 injection to bring it under control?
I also have mild tingling in my feet. Could it mean neuropathy starting?
How often should I do eye and kidney function tests to monitor for diabetes-related complications?
I walk regularly and follow a diet, but weight loss is slow. Could insulin resistance be making it harder, even with regular exercise and controlled meals?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern, and thanks for reaching out.

Your HbA1c (glycated hemoglobin) is still above target despite being on full-dose Metformin. At this stage, the best next step would be to add a medicine from the SGLT2 (sodium-glucose cotransporter-2) inhibitor group, such as Dapagliflozin 10 mg once daily.

It not only helps lower blood sugar but also assists with mild weight loss, apart from other benefits.

The main precautions are to stay well-hydrated and watch for any burning or itching in the private area, as urinary infections can occur in a small number of people.

These are usually mild and respond quickly to treatment. In case cost or tolerance is an issue, we can instead consider adding Glimepiride, starting at 1 mg once daily before breakfast, and increasing to 2 mg if needed and well tolerated.

It works well with Metformin, but should always be taken with regular meals to avoid low blood sugar. As for the GLP-1 (glucagon-like peptide-1) receptor agonists you mentioned, they are indeed excellent drugs, and we might consider them later if required.

These are usually injectable medicines, so they add a bit more complexity with injections and occasional injection-site soreness or mild nausea, which usually settle after a few weeks.

Regarding the tingling in your feet, it could be early diabetic neuropathy, but we should also check your vitamin B12 level, since long-term Metformin use can lower it. If B12 is low, simple supplements correct it quickly.

Persistent burning or numbness may require additional medicines. For monitoring, you should:

Check HbA1c (glycated hemoglobin) every three months until sugars reach target, then every six months.
Get kidney function tests once a year.
Have a dilated eye examination once a year.

You also mentioned slow weight loss despite walking, which is often related to insulin resistance. Keep up your regular walks, but try to add two to three sessions of resistance or strength training each week.

Focus on a balanced, high-protein, high-fiber diet, aim for seven to eight hours of sleep, and manage stress; all of these improve insulin sensitivity and overall health.

I hope this helps.

Thank you.