Brief Answer:
There is a need for further evaluation.

Detailed Answer:
Hi,

Thanks for your question.
Noted your concern.

HbA1c of more than 10 denotes poor control of diabetes.
Considering her I may suggest following evaluation based upon it appropriate changes in treatment may be suggested.
- Complete Blood Count.
- Renal Function Test including Urea, Creatinine, Electrolytes.
- Liver Function Test including Bilirubin, Liver enzymes.
- Urine examination including ketone.
- Lipid Profile.
- ECG and 2D echo of heart.
- Fundoscopy by ophthalmologist to know changes of Diabetic Retinopathy.

Along with this there is a need for detailed physical examination & history taking.

There are many Treatment options available but before suggesting it possible contraindications for their use in particular patients need to be evaluated.
One of the option is to increase dose of Metformin (Content of Glycomet) & Glimepiride (Content of Amaryl) but it should be done with consultation with her treating diabetologist as there may be chances of hypoglycemia (low blood sugar levels) depending upon her physical examination and baseline investigations available.

Hope this helps.
Get back with above evaluation done.

Regards,
Dr Abhay Mali.
Diabetologist.

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Brief Answer:
Deranged Blood sugar levels and Anemia.

Detailed Answer:
Sorry for delayed response.

In your mother's case there is a
- Deranged postprandial blood sugar level and HbA1c.
- Anemia low hemoglobin level.
- Acceptable lipid profile.

In such a case I may suggest
For Blood sugar control-
- Diabetic Diet:
For which it may be advisable to consult near by dietitian who can plan diet for her considering her Body Mass Index and food habits.
- Exercise:
Usual recommendation is 150min per week of moderate degree physical activity depending upon once heart status and effort tolerance.
- Medications:
Here with suggesting one of the combination from different possible combinations but final decision should be taken based on one's detailed history taking, physical examination.
Continue Amaryl 1mg (Glimepiride) and Glycomet (Metformin) 250mg as she already following.
Along with this I may suggest to add combination of Metformin 500mg and Voglibose 0.3mg with lunch.
To recheck blood sugar levels Fasting and postprandial after 3 to 4 weeks further changes in medications may be suggested accordingly.

Anemia Correction:
- Evaluation to know cause of low Hemoglobin
Iron Studies.
Vitamin B12 Level.
- Accordingly Iron and B12 supplements may be suggested.

Screening for diabetic complications-
- Retinopathy screening: To consult ophthalmologist for fundoscopy.
- Diabetic foot examination.
- Urine Albumin creatinine ratio.

Hope this helps.

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