Dr. Sadaf Mustafa
Internal Medicine
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Patient's Query
Hi doctor,
I am a known diabetic for the past 15 years. 20 days ago, my HbA1c was 9.83. I am 54 years old and my weight is 87 kg. My medications are Metformin 500 mg, Hcl 1500 mg, Istavel 100 mg and Glaritus Insulin 30 units. Even then the sugar levels are 246, 265 and 277 after every three hours today. My creatinine, SGOT, SGPT, T3 and TSH are normal.
Hello,
Welcome to icliniq.com.
I have a few questions for you as I would like to know more about your diabetes history. Can you please share what are your morning what are your morning blood sugars in fasting? When do you give yourself Insulin and how often? Have you ever tried a higher dose of Metformin or other diabetes medications? Please share your typical breakfast, lunch and dinner.HbA1c of 9.83 is high. When did you obtain this HbA1C? Did your doctor make any changes? Have you ever used short acting Insulin with each meal? Please answer these questions so that I can guide you in a better way.
Patient's Query
Thank you doctor,
My fasting blood sugar is 170. I am using 20 units of Insulin in the morning and 10 units at night daily. Yes, I tried Metformin Iscept fort morning 2 and evening 2. I had this HbA1c one year before. I used to have two rotis with curry and two big cups of tea for breakfast, two rotis and one cup of rice for lunch and two rotis with two cups of rice and curry for dinner. I never used short acting Insulin.
Hello,
Welcome back to icliniq.com.
Thank you for the detailed history and here are my recommendations.
I suggest increasing the Metformin to 1000 mg twice daily. Glaritus Insulin (Insulin Glargine) works better if given once daily. Try giving yourself 35 units at bedtime once daily. Consult your specialist doctor, discuss with him or her and take the medicine with consent. Reduce one roti from each meal as this will allow reducing your carbohydrate load. Check your blood sugar once in the morning in fasting after 10-12 hours, once before lunch or dinner and once at bedtime and write it down in a book. Your blood sugar should be less than 120 in the morning and less than 180 at other times. Please let me know about your blood sugar numbers after four days of this change. Remember, you have to work on reducing the intake of rice, potato, roti, milk and sugar.
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Internal Medicine
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