Brief Answer:
She need

Detailed Answer:
Hi,

Thanks for your question.
Noted your concern.

Your wife is already on combination of 4 different anti-daibetic medicines.
Tab Zeformin xr 60 conatins Metformin 500 & Giclazide 60mg
Tab Gluconorm G4 Forte contains Metformin 1000mg & Glimepiride 4 mg.
Tab Dyanaglipt 20 contains Teneligliptin 20 mg.

Giclazide and Glimepiride are of same group of anti-diabetic medicines and I never use both in one patient simultaneously.

Fasting Blood sugar of 324 is really high.
You should consult her treating diabetologist immediately.

In such case I usually suggest-
- Detailed physical examination.
- Urine examination including urine ketones.
If urine ketone positive there may be need for hospitalization and intravenous insulin.
- Fasting & Post-prandial blood sugar level.
- HbA1c
- Serum Urea, Creatinine, Electrolytes.
- Liver Function Test.
- Ultra TSH.

Physical examination and above test results will decide need for hospitalization.
If there is no need for hospitalization then I may suggest-
- 1600 kcal diabetic diet.
For which she should consult dietitian who can plan diet for her considering her height and weight (BMI Body Mass Index) and food habits.
- Modification of antidiabetic medicines.
With fasting blood sugar of 324 I may suggest night dose of long acting insulin (Like insulin Glargine) With modification in other oral medicines.
- Once Fasting Blood sugar level fall below 180 start regular exercise usually 150 min per week of moderate degree physical exercise is advisable depending upon her effort tolerance.
- Weight control Try to maintain healthy BMI of less than 23 if possible otherwise below 25.

Better to consult diabetologist or endocrinologist immediately.

Hope this helps.

Regards,
Dr. Abhay Mali.
Diabetoloist.

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