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How Should Persistently High Sugar, Cholesterol And HbA1C Levels Be Managed?

Posted on Wed, 26 Apr 2023

Question: Hi Doctor,

I am 34 years male and not very active.

My Sugar and Cholesterol levels was high from some time, finally in Feb 2017 I am met a Doctor regarding this, he had put me in Pivasta 4 Mg and Onderomet 2.5/500 Mg, when my Sugar levels did not went down (as expected) in 3 months the medicine Onderomet 2.5/1000 was given to me. I am taking the medicine from last 8 months (Pivast 4 MG and Onderomet 2.5/1000), but seems like the Sugar level are controlled. Because of my travel, I am not able to meet the doctor and also not able to do the blood investigation too.
Below are the test results in details. Please suggest the plan forward.
July ’15 – TC – 197 , HBA1C – 6.9
March’ 16 – TC – 234 , HBA1C – 6.7
XXXXXXX ’16 – TC – 204, HBA1C – 6.2
OCT’16 – TC – 230 , HBA1C – 6.7
After that Lab was changed from Thyrocare to different one.
Feb ’17 – TC – 213 and HBA1C – 8.3
June’17 – TC – 152 and HBA1C – 7.4 (Medicine Onderomet changed from 2.5/500 to 2.5/1000)
Oct ‘ 17 – TC – 124 and HBA1C – 6.6
XXXX

Answered by Dr. Saumya Mittal (3 hours later)

Brief Answer:
Suggestions

Detailed Answer:

Hello,

First, your HbA1C appears to be slightly raised in Oct 2017. Normal range is usually below 6. I would ideally recommend rechecking the HbA1C levels again. This can be done at your convenience.

Since the sugars are otherwise well controlled as per your message, I suggest you continue the medication Ondermet as such.

Second, your TC report (I am assuming you mean total cholesterol) report was 124 in Oct 2017. Triglyceride report is not mentioned. Again I would suggest testing a repeat Lipid profile. If the levels are as low as in Oct 2017 (normal range is below 200 in most labs), then I would recommend reducing the dose of Pivast to 2 mg.

I hope this helps. Let me know if I can assist you further.

Best wishes.

Regards,
Dr. Saumya Mittal
Diabetologist

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

Follow up: Dr. Saumya Mittal (20 hours later)

Hi Doctor,

Thanks for Your Reply. You are right Doctor TC is Total Cholesterol only. Please find below my reports with Triglyceride (TGR).

July ’15 – TC – 197 , HBA1C – 6.9, TGR - 185
March’ 16 – TC – 234 , HBA1C – 6.7 , TGR - 215 XXXXXXX ’16 – TC – 204, HBA1C – 6.2, TGR - 228
OCT’16 – TC – 230 , HBA1C – 6.7 , TGR - 238

After that Lab was changed from Thyrocare to different one.

Feb ’17 – TC – 213 and HBA1C – 8.3, TGR - 251
June’17 – TC – 152 and HBA1C – 7.4, TGR – 205 (Medicine changed to 2.5/1000)
Oct ‘ 17 – TC – 124 and HBA1C – 6.6, TGR - 166

Please suggest if I need to reduce the Pivasta dose to 2 mg/ day. How long I need to take this drug?

Also Onderomet 2.5/1000 how long I need to continue?

Regards,
XXXX

Answered by Dr. Saumya Mittal (26 minutes later)

Brief Answer:
Suggestions

Detailed Answer:

Hello,

I would like to reiterate that you need to repeat the tests HbA1c and lipid profile. It's not possible to advice medicinal changes based on the 6-month-old report.

Meanwhile, the sugar medicine Onderomet 2.5/1000 needs to continue. The sugars are in control because you are on medicine. If you stop the medicine, the sugar would rise again.
As for the cholesterol medicine, Pivasta, I have suggested changing the medicine to a lower dose if the new report shows that the levels are low like the last report of Oct 2017. As already said, it is advisable to retest the lipid profile and only then should the medicine be reduced.

Do let us know the latest test reports.

Best of luck.

Regards,
Dr. Saumya Mittal
Diabetologist

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Saumya Mittal (4 days later)

Hi Dr. Mittal,

Good Morning!

I did the tests yesterday (18-3-2018) in Dr. Lal Path Lab. Below are the results:

HBA1c – 6.4
Total Cholesterol – 127
Triglycerides – 192

Please suggest the plan forward now.

Thanks,
XXXX

Answered by Dr. Saumya Mittal (3 hours later)

Brief Answer:
Please continue medicines

Detailed Answer:

Hello,

I would suggest continuing the tablets as such:
* Onderomet 2.5/1000- because the sugars are relatively well controlled
* Pivasta 4 - because triglyceride remain near higher range.

Repeat tests in 3 months.

I hope that helps. Let me know if I can assist you further.

Best wishes.

Regards,
Dr. Saumya Mittal
Diabetologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Saumya Mittal (3 hours later)

Hi Dr. Mittal,

Thanks for your reply.

Pivasta will help in reducing Triglyceride also? Last time Doctor said, this will help to reduce total cholesterol.

Thanks,
XXXX

Answered by Dr. Saumya Mittal (29 minutes later)

Brief Answer:
Should help

Detailed Answer:

Hello,

Your triglycerides are elevated, but not severely. With diet control, exercise and Pivasta, the levels should be controlled.
If not, fenofibrates may be needed and an additional group of medicine may be added.

I hope that helps.

Best wishes.

Regards,
Dr. Saumya Mittal
Diabetologist

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

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