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Suggest Treatment For Diabetes

Posted on Thu, 10 Dec 2015

Question: My mom is about 77 years old. She is hypertensive, diabetic since many years. She had a CABG abot 19 years ago. Since then i have kept her diabetes and lipid profile under control. Although we visit our doctor periodically , what i want to know can you help in doing the medical management for diabetes? I normally check sugar level in glucometer at home and in lab every 2months. I can tell u the medicine she is currently taking and the sugar level being maintained. There are times when she has hypoglycemic symptoms during which medicines were stepped down. Recently she had both back and knee joint pain problem which we could not find any remedy of.

XXXX

Answered by Dr. Dr. Abhay A Mali (57 minutes later)

Brief Answer:
I want to know more about your mother.

Detailed Answer:
Hi,

Thanks for your question.
Noted your concern.

For better opinion I want to know -
- What are the medicines she is taking including antidiabetic and other?
- What are her current blood sugar levels?
- Test results of following investigations even if done in last 3 to 6 months-
> Haemogram.
> Renal function test- urea, cratinine, electrolytes, uric acid.
> Lipid Profile.
> HbA1c.
> T3, T4, TSH.
> Vitamin D3, B12
> 2DEcho of heart (Left Ventricular Ejection Fraction, LVEF)
> Urine albumin creatinine ratio.
> Ultrasound of abdomen and pelvis.
> Fundoscopy for diabetic retinopathy.

Waiting for your reply.

Regards,
Dr. Abhay Mali.
Diabetologist.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Abhay A Mali (20 hours later)

Dear dr Abay

Currently i am out of station and it wont be possible for me to get all the test u mentioned. However i can tell u that she is stable since last 18 years and we normally get her sugar createnin and lipid profile tested by our physisician at regular interval. I thought this could be a good way to manage her medicines for diabetes as i am not in the town many times. I will let u know the list of medicines she is currently taking by today.

Just to inform you that her blood createnime levels have been normal since last 19 years. Her sugar levels are always below 200. Some times she had shown hypoglycemic symptoms. Currently she is quite stable.

XXXX

Answered by Dr. Dr. Abhay A Mali (1 hour later)

Brief Answer:
Let me know her medicines.

Detailed Answer:
Thanks.

As duration of diabetes advances usually there may be deterioration of kidney function.
Deteriorated kidney function may leads to inadequate clearance of antidiabetic medicines from body.
It leads to undue prolongation of duration of action of antidiabetic medicines and there may episodes of hypoglycemia.

Same thing may happen with deranged liver function.

Accordingly there may be need to change the dose of current medicines or even may need change in type of medicines.

Let me know the list of medicines she is taking.

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Dr. Abhay A Mali (20 hours later)

These r the medicine she is currently taking. The only difference is Melmet SR 500 is 1 tab at night and not half. And the last 4 are on need basis. Rest r all regular. As I check BP and sugar regularly at home the are mostly in the normal range.

Answered by Dr. Dr. Abhay A Mali (10 hours later)

Brief Answer:
Hypoglycemia can be prevented by changes in medicines.

Detailed Answer:
After going through your mother's prescription there are 2 antidiabetic medicines she is taking.
1) Tab Carbophage G1 which contains Metformin 500mg & Glimepiride 1mg.
2) Tab Melmet SR 500 contains Metformin 500mg.

It means your mother is taking Metformin 1000mg and Glimepiride 1mg per day.

Hypoglycemia and relation to these 2 drugs-
- Metformin act on insulin resistance and it very rarely cause hypoglycemia when used alone.
- Glimepiride stimulates insulin secretion from pancreas. It has potential to cause hypoglycemia even when used alone, risk increases with concomitant use of other antidiabetic medicine like Metformin.

If hypoglycemia is a real worry (which need to be evaluated going through detailed history taking- frequency of hypoglycemic episodes, type of symptoms, severity of symptoms, need of assistance from others, any aggravating factors)
then the option is to stop Glimepiride and increase the dose of Metformin (considering normal kidney and heart function) with or without addition of antidiabetic medicines which rarely cause hypoglycemia when used with metformin like DPP4 inhibitors or Alpha Glucosidase Inhibitors or SGLT2 inhibitors.
Along with this close monitoring of Blood sugar level Fasting, Postprandial & HbA1c is advisable.

Option need to be discussed with her treating physician.

All other medicines can be continued safely which have no relation with hypoglycemia.

Hope this help your mother.
I will be happy to answer your future questions if any.
You can close the question and rate the answer.

Regards,
Dr. Abhay Mali.

In future if you want you can directly ask questions to me on following link-
http://www.HealthcareMagic.com/doctors/dr-abhay-a-mali/69954

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr. Abhay A Mali (2 days later)

Thanks for your advice
Well actually hypoglycemia is not really a problem at the moment. I checked the sugar levels twice in last week in fasting and they were in the range of 116 and 111.

I think nothing much is tequired now. I will keep u informed of things in future.

Answered by Dr. Dr. Abhay A Mali (11 hours later)

Brief Answer:
Thanks.

Detailed Answer:
Thanks XXXX.

I will be happy to answer your future questions.

Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj