Brief Answer:
Blood sugar levels need to be controlled

Detailed Answer:
Hello and welcome,

You are currently taking sitagliptin (istavel) and gliclazide XR (gliclazide) and your sugar levels are not well controlled. You want to add a medicine/ change doses so that you are able to tolerate medicines and control diabetes.
As mentioned by yourself, metformin causes heaviness in stomach and acidity, so you are not able to tolerate it.

Usual recommendation is to add metformin and if you can tolerate it, you can continue. Otherwise medicine like dapagliflozin need to be added. Usually not more than two antidiabetic drugs should be taken. Third drug is added only in selected cases where they are able to tolerate them. If diabetes type 2 is uncontrolled with two medicines, then insulin should be considered.

You may try the following ayurveda medicine to control blood sugar: XXXXXXX XXXXXXX Tattva Nishamalakki once or twice a day as needed.

In my opinion, you may try adding Nishamalakki to your current regimen and re-check blood sugar levels in 10 days.
I hope that you are exercising regularly and following a diet plan. Drinking cleaner water can also help especially when upset stomach is the problem. Also exclude the foods like bread or spicy foods that can cause acidity. Have a glucometer at home to check blood sugar levels yourself.

Hope this answers your query. Let me know if I can assist you further.
Dr Vaishalee

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Brief Answer:
Hypoglycemia

Detailed Answer:
Hi again,

Thanks for reverting with details.

Your blood sugar levels are going a bit on lower side (hypoglycemia). And gliclazide can cause hypoglycemia when metformin or insulin is added with it. So yes, Gliclazide morning dose should be halved or removed.
Let us add one medicine at a time. Now that you have added metformin, so you may delay adding nishamalaki for one week. Meanwhile, keep a track of blood sugar levels.

Regards,
Dr Vaishalee

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Brief Answer:
I think you are doing fine on current regimen

Detailed Answer:
Hi again,

If you are doing fine with current regimen, you may continue it.

Regarding your specific queries:
Glimepride and gliclazide are both sulfonulureas with same action. Some differences are: glimepride inhibits platelets and make blood thin, so more useful in patients with blood clots. It is also required to take in divided doses whereas gliclazide is longer acting and once once a day dose suffices.

Istamet-XR-CP is an extended release and high dose version of Istamet. Extended release means that due to special coating, this tablet will release medicine over an extended period of time, possibly around 6-8 hrs. It is needed when patient doesnot want to take more than one tablet in a day or a more rigorous control of blood sugar levels is needed for more time.
If Istamet is working for you and not producing side effects, then it is good. It depends on how much you can tolerate this medicine.
Regimen of glimpride (2mg)+ Metformin (500 mg) extended release (1-0-0) and sitagliptin 50mg and metformin 500 mg in night (0-0-1) has metformin twice a day. Since you had some issues with Metformin, you were started on other medicines like sitagliptin and gliclazide. According to guidelines, if you are doing fine with metformin once or twice a day, then other medicines are not needed. If your blood sugar levels go up with metformin alone or you are experiencing some side effects, then it is better to add other medicines one at a time.
Becosules is a good vitamin B complex.
Karela Jamun juice also works.

Regards,
Dr Vaishalee

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