Brief Answer:
Glucose levels better - needs improvement though

Detailed Answer:
Dear Mr. XXXXXXX
Good morning. This is Dr Praveen here and I will be answering your query today.

Mr. XXXXXXX if I may summarize your history. You are 56 year old, a diabetic since 4 yrs roughly with dylipidemia (cholesterol issues) and a history of urinary tract infection (UTI) in XXXXXXX 2015 for which antibiotics were prescribed. The UTI was probably a result of uncontrolled diabetes. Other reports showed uncontrolled diabetes (A1c 14.9 with FBS 297). Triglycerides was 175 and LDL 145 which was both out of range. Renal (kidney) functions were within normal limits. Janumet 50/500 twice a day and lipomax 10 was given to you.

After a month or so, your fbs was 141 with normal renal functions. Janumet was increased to 50/1000 1 bd and pioglitazone was added. Lipids medication was increased to 20 mg at night.

I understand why you are hesitant to take the prescription. You probably feel the medications are of a higher dose.

To analyse your prescription now you are on janumet 50/1000 which has two medicines in it - one is sitagliptin and the other is metformin. Both are time tested medications and very effective in controlling diabetes. All medications in diabetes and for that matter in other conditions are given after rigourous asessment of their benefits vs side effects and then the optimal doses are decided. Sitagliptin 100 mg per day is the optimal dose where metformin can be used upto 3 gm in some patients. Both have the advantage of being weight neutral. So in your case being a type 2 diabetic and I assume you are overweight they are good drugs which can be taken without any hesitation. Let me assure you that in the long run your efforts to control diabetes with good diet control, exercise and medications will pay off. So don't worry. Its not too strong. Its what your body needs. BUt I am sure after about 3 months your doses will need reduction because your body would have come out of the phase of glucotoxicity (where high glucose levels decrease the release of insulin from the pancreas which will improve after a period of good sugar control).

The next medication is pioglitazone which is also a good drug. It can increase weight slightly but since you are on januvia its likely for the effect to be cancelled out. The advantage of using janumet and pioglitazone together is that they dont cause low sugars (hypoglycemia). Put together they have a good effects on your cholesterol levels as well. Your cholesterol medications are correct at 20 mg which is the dose advised according to all guidelines by leading cardiology associations world over for patients with diabetes.

So, in my opinion you should continue the medications the doctor has advised without any worry. It will work and your sugars will be controlled. Your hba1c needs be less than 7% which will take about 3-4 months. So be patient. Keep on with very good diet control - eat healthy. Exercise for 40 mt daily. Keep your mind calm. Take your medications regularly and it will all be fine.

Your targets:
FBS 45
BP <130/80

I will be happy to advise if you have any further queries.
Wishing you good health
Take care
Warm regards,
Dr Praveen

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Brief Answer:
Honest reply for sure. Don't worry. Assured.

Detailed Answer:
Dear Mr XXXXXXX
Yes. Your weight is well in the normal range. Diabetes is known to decrease weight because your body is deprived of energy though glucose levels are high in the blood and the body starts using its own reserves of protein and fat. Hence the weight loss. But now that you are in the normal range, its good to stay in the range with the appropriate diet control measures and exercise you are taking.

Secondly, regarding the side effects. Every medications has a side effect. Metformin - has gastric side effects like abdominal pain, gaseous distension and in long term use can cause anemia. But remember,with appropriate followup you will be screened for everything and accordingly advised. Sitagliptin - very rarely is known to cause panreatitis in a few individuals who use alcohol and has a prior history - but again you have been on it and are doing well. So that is fine. Your liver enzymes need to be monitored which the doctor did and is in the normal range. Piogltazone is not to be used in patients with cardiac failure and post menopausal women. So no issue in your case.

Remember, every drug has its effect and side effects. Plants and herbs used in ayurveda are not immune to it. There are lots of reports of heavy metal use in ayurveda as well. And moreover, in todays day and age of scientific advancement its all to do with evidence based medicine and the medications you are taking have been tried and studied extensively before use.

I am speaking to you as a doctor and friend and there is no issue about me supporting another doctor just for name sake. No doctor will harm his patient and I can speak to you on everyone's behalf about that. I understand your concern and I hope I have explained to alleviate it. Many many patients loose valuable time early on in the disease contemplating over if/when to take medications and later on develop complications even if controlled - that is called metabolic memory (your cells remember how it has been treated - so let us start early and keep it controlled well.

Not one thing will help. Diet, exercise and medications go hand in hand. Honestly, your medications are right. Please take it. Followup systematically every month and after 3-4 months your medications need to be decreased. Life style as you know has to continue.

Regarding foods - Avoid refined sugar and products with high fructose corn syrup. You may have rice or wheat but portion size is important and always couple it with pulses / veggies to prevent rapid rise in glucose. Use low fat dairy. Use salt normally but avoid high salt items. Avoid fried foods. Eat several times during the day. 8 am break fast, 2 lunch, 8 dinner with small mid meal snack at 11 5 and 10 pm. Split your food for better results. There is a little article on fruits which I think will help:

Fruits – divided into low, medium or high sugar content (per ½ cup serving)
LOW TO MEDIUM SUGAR CONTENT
Berries – lowest in sugar especially (RBC – raspberry, blackberry, cranberry)
Spring summer fruits – Peach, nectarine, melon (casaba, watermelon, cantaloupe and honeydew), apricot

MEDIUM TO HIGH SUGAR CONTENT
Fall winter fruits – apples, citrus fruits, kiwi, plums, pears.
Least sugary in this category – grapefruit and apples.
HIGH SUGAR CONTENT
Tropical fruits – pineapple, pomegranate, XXXXXXX banana, fresh fig, jackfruit.
Least sugary in this category – papaya and guava.
Non tropical fruit high in sugar – tangerine, cherry and grapes
Dried fruits – ALL have high sugar content – dates, raisins, prunes, apricots, figs. Dried berries are processed with sugar for better taste.
Alternative to dried fruit is freeze dried and dehydrated summer fruits and berries

Hope this helps. Take care.
Regards
Dr Praveen

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Brief Answer:
Very glad to know that

Detailed Answer:
Dear Mr XXXXXXX .I totally understand why you were so hesitant to take the medications. I am so glad that you feel better and ready to face the condition head on. Wishing you the best of health. Please keep me periodically updated on your progress. Take care. Warm regards. Dr Praveen.

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