Brief Answer:
Further evaluation is advisable.

Detailed Answer:
Hi,
Thanks for your question.

Your mother has uncontrolled blood sugar levels.
Taking in to consideration of uncontrolled diabetes and history of blood pressure your mother is at risk of vascular complication, she needs further evaluation.
It may be advisable to do following investigations for her-
1) HbA1c it will give better idea of her blood sugar level over period of 3 to 4 months.
2) Lipid profile.
3) Kidney function tests including serum creatinine, urea, electrolyes, uric acid, ultrasound of abdomen and pelvis.
4) ECG & 2DEcho of heart to know pumping of heart.
5) Fundoscopy for diabetic & hypertensive retinopathy.
6) Foot examination for neuropathy and vasculopathy.

Now coming to your question regarding her medicines-
If similar situation is present in my patient I would have been advised-
1) To continue Telvas AM, Nitrilix, Neurokind next, D3 60k depending on kidney function.
2) To avoid painkiller (NSAID group combiflame is one of it) due to risk of kidney injury. If really needed alternative painkillers safe with kidney function may have used.
3) For diabetes control if kidney function and heart pumping capacity is normal I would have been suggested combination of Metformin (in maximal tolerable dose 1500 to 2000mg daily in divided dose) with DPP4 inhibitor (Linagliptin 5mg daily dose which is safe even with renal impairement) with probably small dose of basal insulin (glargine).
4) To take statin (cholesterol lowering drug) even with normal lipid profile, only dose will depend on lipid levels.
5) Use of Golbi depending on liver function.

Hope I have answered your question.
I will be happy to answer your follow up question if any, otherwise you can close the discussion and rate the answer.

Regards,
Dr. Abhay Mali.
Diabetologist.

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Brief Answer:
Yes but in certain situations.

Detailed Answer:
Hi XXXX,

Thanks for follow up question.
Tab Tribet 2 contains metformin 500 + piogltazone 15 mg + glimeperide 2mg.
Tab Gemer 2 contains metformin 500 + glimeperide 2mg.

I usually avoid use of pioglitazone in certain situations-
1) In obese person as it has tendency to gain weight.
2) Postmenopausal female as pioglitazone is found to associated with osteoporotic fractures of long bones.
3) In person with tendency to retain water as in kidney problem or heart problem.

Also addition of piogltazone to previous combination of metformin and glimeperide may not suffice with blood sugar level of 201 & 401 (of course you have not mentioned the frequency of taking medicines).

I would have preferred the use of Tribet 2 only in case of financial issue with patient refused to use of insulin, as Tribet 2 may be more economical than other newer oral antidiabetics.

Here I have tried to give indirect information rather than giving direct answer.
Your doctor can suggest best option suitable to your mother taking in consideration of previous medical records and socioeconomical issues.

Hope I have answered your question.
If so close the question and rate the answer.

Regards,
Dr. Abhay Mali.
Diabetologist.

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Brief Answer:
Strict diabetes control and diet modification may help.

Detailed Answer:
Hi,
In your mother there may be diabetic gastropathy.
She needs -
1) Strict blood sugar control as early as possible.
2) Changes in diet like drinking adequate water, use of high fiber diet (like green leafy vegetables, fruits, sprouted nuts), spacing meals, taking small quantity frequent meals.
3) Avoid late night dinner.
4) Avoid immediate lying down after having meals.
5) Use of antacids, prokinetic medicine after discussing with your doctor.
6) Continue using syrup looz.

Hope this may be helpful to your mother.
If so close the question and rate the answer.

Regards,
Dr. Abhay Mali.
Diabetologist.

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