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Can Asomex And Acarbose Be Discontinued Without Doctor's Consent?
Question: I consulted doctor around 8-month back. He diagnosed sugar at 140 mg/dl and B.P at 98/160 and prescribed Acarbose-25 mg and Asomex-5. I continue using medicine and my glucose level came down to 110 mg/dl and B.P to 82/130.
My consulting doctor has left my town. Consulting him on telephone on my enquiry, he suggested me to discontinue medicine .
Since last two months, I am not using any medicine, however I continue doing exercise and meditation. Interestingly my glucose level has further fallen to 104 mg/dl without any medicine, but BP has gone to 97/160 without medicine.
Please suggest, shall I continue and wait to see next observation before medication and, if no, should I take Asomex 2.5 to reduce my BP.
As my favourite doctor in not in Town, I will prefer to contact your site. May please suggest. Regards
My consulting doctor has left my town. Consulting him on telephone on my enquiry, he suggested me to discontinue medicine .
Since last two months, I am not using any medicine, however I continue doing exercise and meditation. Interestingly my glucose level has further fallen to 104 mg/dl without any medicine, but BP has gone to 97/160 without medicine.
Please suggest, shall I continue and wait to see next observation before medication and, if no, should I take Asomex 2.5 to reduce my BP.
As my favourite doctor in not in Town, I will prefer to contact your site. May please suggest. Regards
Brief Answer:
please take the ASOMEX 2.5 mg
Detailed Answer:
Hello XXXX, Welcome back to HCM,
I've gone through query in details and understand your concern,
Yes, it's rather interesting finding what you've described, but I feel there must be another explanation for this, as proper diet habits, active work-outs have direct impact on the blood sugar control, that's why we always advice lifestyle modifications in the first place if found early diabetic..
You may get a repeat investigation for FBS, PPBS(2 Hr post prandial) along with HBA1C and urine R.M to look in to this further later on..
As of now, please take the ASOMEX 2.5 mg and keep monitoring the Blood pressure on regular basis..please make a proper chart with a timely interval of ~ 2-3 hrs (starting from morning till few minutes before bedtime) and do observe the trend..
You can let me know in the due course or even report to your treating doctor, as I feel you'll be requiring the anti-hypertensive dose modification after this..please also make sure to have a fresh 12 lead ECG later on for further evaluation in to this..
If you observe the range of BP is around 150-160/89-100 mmhg range, please start taking ASOMEX 2.5 mg on Daily basis after informing your treating doctor also, and observe and record the trend, if despite this it remains in the higher range then further dose and regimen modification will be required..
Don't worry, it'll be fine within a matter of time only..
Let me know how you stay in he due course..
Take Care
Kind Regards
please take the ASOMEX 2.5 mg
Detailed Answer:
Hello XXXX, Welcome back to HCM,
I've gone through query in details and understand your concern,
Yes, it's rather interesting finding what you've described, but I feel there must be another explanation for this, as proper diet habits, active work-outs have direct impact on the blood sugar control, that's why we always advice lifestyle modifications in the first place if found early diabetic..
You may get a repeat investigation for FBS, PPBS(2 Hr post prandial) along with HBA1C and urine R.M to look in to this further later on..
As of now, please take the ASOMEX 2.5 mg and keep monitoring the Blood pressure on regular basis..please make a proper chart with a timely interval of ~ 2-3 hrs (starting from morning till few minutes before bedtime) and do observe the trend..
You can let me know in the due course or even report to your treating doctor, as I feel you'll be requiring the anti-hypertensive dose modification after this..please also make sure to have a fresh 12 lead ECG later on for further evaluation in to this..
If you observe the range of BP is around 150-160/89-100 mmhg range, please start taking ASOMEX 2.5 mg on Daily basis after informing your treating doctor also, and observe and record the trend, if despite this it remains in the higher range then further dose and regimen modification will be required..
Don't worry, it'll be fine within a matter of time only..
Let me know how you stay in he due course..
Take Care
Kind Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thanks Doctor for your reply. I will keep a followup of my BP 2- hourly basis and will let you know. In the meantime I will take Asomex 2.5 mg as advised as per reading available.
Tomorrow I will make a fresh glucose check up as advised and will forward the reading to you.
Now your advice will be highly appreciated for the following reason.
1. I am feeling mild pain almost constantly more so in the morning at the lower left side bottom at my stomach.
2. I have minor constipation and I have harder stool in the beginning of my stool pass every time.
3. There is no time frame of nature call to go to toilet.
4. Though not restricted but I do not have free flowing urination.
5. Is there possibility of stone formation at Gall bladder etc. However on my annual check up nothing such was found other than some urine remain collected even after urination.
I am a bit puzzled for continuous pain at lower side of stomach and lower back, however it is mild.
Sorry for late reply and query. I will be more attentive to check your return mail. Please reply soon. Regards
Tomorrow I will make a fresh glucose check up as advised and will forward the reading to you.
Now your advice will be highly appreciated for the following reason.
1. I am feeling mild pain almost constantly more so in the morning at the lower left side bottom at my stomach.
2. I have minor constipation and I have harder stool in the beginning of my stool pass every time.
3. There is no time frame of nature call to go to toilet.
4. Though not restricted but I do not have free flowing urination.
5. Is there possibility of stone formation at Gall bladder etc. However on my annual check up nothing such was found other than some urine remain collected even after urination.
I am a bit puzzled for continuous pain at lower side of stomach and lower back, however it is mild.
Sorry for late reply and query. I will be more attentive to check your return mail. Please reply soon. Regards
Brief Answer:
multi-system involvement, thorough investigation and clinical examination required..
Detailed Answer:
Hello XXXX, Welcome back,
Thanks for following up with these details,
There're multi-system involvement as per the list of complaints. so you need to be thoroughly investigated for this and need to be properly clinically examined to decide on the further course of management..
I'm going to describe the plan of management in order of your questionnaire only, step by step below, please follow them:
1. It can be due to the ongoing constipation only as mentioned in 2.& 3.
However, in view of your age(57yr), a suspected Pre-Diabetic & Hypertensive status, you should get thoroughly evaluated for this (a fresh 12 lead ECG, 2D-Echocardiogram and a TMT- to rule out any underlying angina to be done under the supervision of a Cardiologist preferably and/ an Internal medicine specialist who'll also take a detailed look at the blood sugar monitoring)..
Please stop smoking, if any, need to cut down on the amount of alcohol, if any..
2. Stay well hydrated by drinking a lot of water, have lot of high fiber food (fresh green leafy vegetables, replacing regular wheat/refined flour to whole wheat & whole grain, almonds, ground nuts etc.) which helps in bulk formation and prevents constipation in long term..
If despite doing these for few days, there's no significant improvement, then Syp LACTULOSE 10-15 ml after dinner will be helpful (you can titrate the dosage accordingly as per your body's response and number of motion)..
3. Bowel hygiene is important, try to practice a fixed timing for bowel habits (eg. in morning after drinking 2 glass of water and some light exercises, getting up from bed).. all the above mentioned measures will be helpful for this..
4. & 5. are inter-related.. first of all, there's always some chance of stone formation in every individual with further progression of age, food habits, life style etc. Thus maintenance of good hydration status, avoiding too many tea/coffee all play a vital role..however there's hardly any indication for gall bladder stones as per these descriptions..
The urinary flow and post-void residual urine have to be evaluated in details by any Urologist to rule out BPH (it's quite common in men after the age of 50 yrs), so USG KUB+Prostate+PVRU should be done along with uroflowmetry and serum PSA.. it's important as any stagnant residual urine volume in side the urinary bladder can become a reservoir of pathogen (since you've already mentioned in your annual check-up there was such findings)..
Don't be puzzled , just follow these necessary advises to get properly investigated and examined by the relevant specialists as I've mentioned, you should be fine..Blood sugar examination can planned along with the other check-ups to avoid multiple sampling and inconvenience after the clinical examination..
None of the symptoms are too severe, but needs timely intervention and routine follow-up(clinically by the relevant specialist) for future well being..
Let me know if there's any further queries..
Take Care
Kind Regards
multi-system involvement, thorough investigation and clinical examination required..
Detailed Answer:
Hello XXXX, Welcome back,
Thanks for following up with these details,
There're multi-system involvement as per the list of complaints. so you need to be thoroughly investigated for this and need to be properly clinically examined to decide on the further course of management..
I'm going to describe the plan of management in order of your questionnaire only, step by step below, please follow them:
1. It can be due to the ongoing constipation only as mentioned in 2.& 3.
However, in view of your age(57yr), a suspected Pre-Diabetic & Hypertensive status, you should get thoroughly evaluated for this (a fresh 12 lead ECG, 2D-Echocardiogram and a TMT- to rule out any underlying angina to be done under the supervision of a Cardiologist preferably and/ an Internal medicine specialist who'll also take a detailed look at the blood sugar monitoring)..
Please stop smoking, if any, need to cut down on the amount of alcohol, if any..
2. Stay well hydrated by drinking a lot of water, have lot of high fiber food (fresh green leafy vegetables, replacing regular wheat/refined flour to whole wheat & whole grain, almonds, ground nuts etc.) which helps in bulk formation and prevents constipation in long term..
If despite doing these for few days, there's no significant improvement, then Syp LACTULOSE 10-15 ml after dinner will be helpful (you can titrate the dosage accordingly as per your body's response and number of motion)..
3. Bowel hygiene is important, try to practice a fixed timing for bowel habits (eg. in morning after drinking 2 glass of water and some light exercises, getting up from bed).. all the above mentioned measures will be helpful for this..
4. & 5. are inter-related.. first of all, there's always some chance of stone formation in every individual with further progression of age, food habits, life style etc. Thus maintenance of good hydration status, avoiding too many tea/coffee all play a vital role..however there's hardly any indication for gall bladder stones as per these descriptions..
The urinary flow and post-void residual urine have to be evaluated in details by any Urologist to rule out BPH (it's quite common in men after the age of 50 yrs), so USG KUB+Prostate+PVRU should be done along with uroflowmetry and serum PSA.. it's important as any stagnant residual urine volume in side the urinary bladder can become a reservoir of pathogen (since you've already mentioned in your annual check-up there was such findings)..
Don't be puzzled , just follow these necessary advises to get properly investigated and examined by the relevant specialists as I've mentioned, you should be fine..Blood sugar examination can planned along with the other check-ups to avoid multiple sampling and inconvenience after the clinical examination..
None of the symptoms are too severe, but needs timely intervention and routine follow-up(clinically by the relevant specialist) for future well being..
Let me know if there's any further queries..
Take Care
Kind Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thanks Doctor
I have gone for Glucose checking the reading as follows:
Fasting Blood Glucose: 121 mg/dl
After meal -2hours hence: 158 mg/dl
I am taking no medicine since more than two months for glucose. However the earlier reading was 104 mg/dl.
I am taking rice in lunch period, however due to reasons i was not regular for walking.
After taking Asomex-2.5, the BP reading showing at XXXXXXX 88/142
My query ;
1. Shall I take medicine for glucose or continue maintaining my physical exercise and regular walking.
2. What should be my food habit. If you please suggest for Morning, lunch and dinner.
3. shall i take any supplementary drink etc.
4. I will go for through medical check up as suggested by you and will contact you in a week time.
Your detail answer suggests your caring nature as medical practitioner. Keep it up. Regards
I have gone for Glucose checking the reading as follows:
Fasting Blood Glucose: 121 mg/dl
After meal -2hours hence: 158 mg/dl
I am taking no medicine since more than two months for glucose. However the earlier reading was 104 mg/dl.
I am taking rice in lunch period, however due to reasons i was not regular for walking.
After taking Asomex-2.5, the BP reading showing at XXXXXXX 88/142
My query ;
1. Shall I take medicine for glucose or continue maintaining my physical exercise and regular walking.
2. What should be my food habit. If you please suggest for Morning, lunch and dinner.
3. shall i take any supplementary drink etc.
4. I will go for through medical check up as suggested by you and will contact you in a week time.
Your detail answer suggests your caring nature as medical practitioner. Keep it up. Regards
Brief Answer:
follow-up consultation..
Detailed Answer:
Hello XXXX, Welcome back,
Thanks for following up with these details,
Yes, ASOMEX 2.5 mg should be continued along with BP recording trends, and target level of 130-140/70-80 mmhg should be kept..(if despite this, the BP doesn't come down in this range then I'd suggest the Cardiology consultation earlier for a detailed clinical examination prior to decide another anti-hypertensive agent therapy along with all those investigations as already mentioned)..
If you go back to the very first reply of mine, you'll be finding that I've mentioned to get done FBS, PPBS(2 Hr post prandial) along with 'HBA1C', as it'll give a complete idea of the present glycemic status..
So, as per your query,
1. HBA1C should be done for determination of the glycemic control, followed by a thorough clinical examination by either an Internal Medicine specialist/ Endocrinologist to determine the extent of the pathologies (Acarbose is not the first drug of choice to start with in Diabetics, however some physicians do prefer it in pre-diabetics, thus a proper clinical evaluation is mandatory to determine on this further)..
2. When deciding on food habits specially for pre-diebetes/Diabetes it's always wise to contact the Dietitian for a flexible pre-set comprehensive diet chart (You can request for Diet chart here in this portal only (there are specific options for this), the Dietitian will get in touch with you at the earliest)..do mention your present body weight, height, daily activities, food preferences(if any) to the dietitian for a comprehensive diet chart ..
In general, try to avoid carbohydrate rich, high sugar containing foods,
Yes, one small cup of rice can be taken at lunch, but do try to have roti/dry chapatis (preferably whole wheat and whole grains)..along with it seasonal vegetables, and salads can be fine..
Try not take sugar in tea/coffee.. avoid high sugar containing fruits/veggies like potato, banana, XXXXXXX etc. have cucumber, apple, papaya, guava etc.
Briefly, Morning- sugarless tea/coffee with one/two whole grain biscuits, 1 small cup of poha, one boiled egg etc.
Lunch - 3 chapatis, 1 small cup of rice, 1 medium cup of salad, small cup veggies and sugarless curd/yogurt..
Fresh cut Fruits (low carbohydrate as already mentioned) in the evening as snacks and a cup of green tea..
Dinner - 2-3 chapatis, 1 serving of seasonal veggies (specification can be obtained from the dietitian), sprout salad, fish or occassionally chicken(if you consume) ..
3. Supplements are not recommended in an otherwise healthy adult unless any specific deficiency is detected, so please get yourself examined and evaluated thoroughly as mentioned to determine on this (however from your descriptions, there's no such need of supplementation as of now)..
4. Yes please get them done thoroughly, and also get yourself examined properly by the Internal medicine specialist and/ Cardiologist/endocrinologist in the first place followed by the Urologist in subsequent course as already explained..
Take Care
Kind Regards
follow-up consultation..
Detailed Answer:
Hello XXXX, Welcome back,
Thanks for following up with these details,
Yes, ASOMEX 2.5 mg should be continued along with BP recording trends, and target level of 130-140/70-80 mmhg should be kept..(if despite this, the BP doesn't come down in this range then I'd suggest the Cardiology consultation earlier for a detailed clinical examination prior to decide another anti-hypertensive agent therapy along with all those investigations as already mentioned)..
If you go back to the very first reply of mine, you'll be finding that I've mentioned to get done FBS, PPBS(2 Hr post prandial) along with 'HBA1C', as it'll give a complete idea of the present glycemic status..
So, as per your query,
1. HBA1C should be done for determination of the glycemic control, followed by a thorough clinical examination by either an Internal Medicine specialist/ Endocrinologist to determine the extent of the pathologies (Acarbose is not the first drug of choice to start with in Diabetics, however some physicians do prefer it in pre-diabetics, thus a proper clinical evaluation is mandatory to determine on this further)..
2. When deciding on food habits specially for pre-diebetes/Diabetes it's always wise to contact the Dietitian for a flexible pre-set comprehensive diet chart (You can request for Diet chart here in this portal only (there are specific options for this), the Dietitian will get in touch with you at the earliest)..do mention your present body weight, height, daily activities, food preferences(if any) to the dietitian for a comprehensive diet chart ..
In general, try to avoid carbohydrate rich, high sugar containing foods,
Yes, one small cup of rice can be taken at lunch, but do try to have roti/dry chapatis (preferably whole wheat and whole grains)..along with it seasonal vegetables, and salads can be fine..
Try not take sugar in tea/coffee.. avoid high sugar containing fruits/veggies like potato, banana, XXXXXXX etc. have cucumber, apple, papaya, guava etc.
Briefly, Morning- sugarless tea/coffee with one/two whole grain biscuits, 1 small cup of poha, one boiled egg etc.
Lunch - 3 chapatis, 1 small cup of rice, 1 medium cup of salad, small cup veggies and sugarless curd/yogurt..
Fresh cut Fruits (low carbohydrate as already mentioned) in the evening as snacks and a cup of green tea..
Dinner - 2-3 chapatis, 1 serving of seasonal veggies (specification can be obtained from the dietitian), sprout salad, fish or occassionally chicken(if you consume) ..
3. Supplements are not recommended in an otherwise healthy adult unless any specific deficiency is detected, so please get yourself examined and evaluated thoroughly as mentioned to determine on this (however from your descriptions, there's no such need of supplementation as of now)..
4. Yes please get them done thoroughly, and also get yourself examined properly by the Internal medicine specialist and/ Cardiologist/endocrinologist in the first place followed by the Urologist in subsequent course as already explained..
Take Care
Kind Regards
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Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Answered by
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