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On Human mixtard coupled with Mclazide. Weight gain. Stopped Piopar and Janumet. Prescribed MclazideM with Glyciphage500. Guide?

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I was put on a dose of Human mixtard 20/12 coupled with Mclazide M (TDS), Voglimit 0.3 (TDS),Janumet 50/500(BD) and Piopar 15 mg (OD) and sugar levels were under control though not satisfactory. FB had been swinging around 150 and PP around 200 since last two years with above treatment in Mumbai. My weight had increased by almost 18 kg in two years.
Recently I shifted to Delhi and consulted an specialist Endocrinologist and he opined that above combination had resulted in weight gain and needs to be changed. Now he has deleted Piopar and Janumet and substituted MclazideM with Glyciphage500. Additionally he has prescribed Victoza 1.2 mg daily along with 20/18 Human mixtard ( originally he had given Humalog 25 @ 16/12 for 3 weeks but changed to Mixtard yesterday). However, my Fasting and PP levels are now swinging between 350 and 450 respectively since last 3-5 days. Kly advise
Posted Tue, 8 Oct 2013 in Thyroid Problem and Hormonal Problems
Answered by Dr. Minal Mohit 9 hours later
Brief Answer:
Need further adjustment for diabetes.

Detailed Answer:
Dear ma'm,

It was nice of you to put up your queries at XXXXXXX Ma'm i'll try to explain, initially you were on Gliclazide three times a day (probably 120mg), metformin 2.5 g /d, voglibose .3mg three times /day, vildagliptine 100 mg, pioglitazone 30mg, and above that on insulin. Now your pioglitazone, vildagliptine, and gliclazide have been withdrawn and metformin has been reduced significantly. All these are very strong hypoglycemic agents. So the sugar levels are bound to go high. You will need time and patience to regulate your sugars. These medicines, specially Pioglitazone has the reputation to make you gain weight.

Besides you have a history of thyroid disorder and hypertension. So to explain weight gain I need your recent thyroid profile as well. Besides, diet and exercise schedule play an important role. So please let me know your life style as well.

I will be able to comment on your current concern, if you can provide the above necessary details.

Awaiting your reply...

Take care of your sugars and weight too!
Above answer was peer-reviewed by
Follow-up: On Human mixtard coupled with Mclazide. Weight gain. Stopped Piopar and Janumet. Prescribed MclazideM with Glyciphage500. Guide? 1 hour later
You hv not commented on the new course of treatment in Delhi and also on the likely effectivity of Victoza 1.2 unit daily. Is the new course of treatment particularly withdrawing Pioglitazone better?
Also do we require hospitalisation at this stage ?
Answered by Dr. Minal Mohit 5 hours later
Brief Answer:
blood glucose can be managed on OPD basis.

Detailed Answer:
Dear Ma'm, I am sorry if some confusion still remains. I'll try to elaborate more.
1. The new course in Delhi is really a good one, only thing is, it will take time and dose adjustment to regulate blood glucose.
2. Victoza, i.e. liraglutide is a good and effective drug, specially when we are focusing weight loss.
3. Pioglitazone is the drug known notoriously for weight gain, so any patient complaining of weight gain and is on pioglitazone, we take off pioglitazone thinking it to be the culprit. So it was the good decision.
4. As far as hospitalization is concerned, that can be answered only after examining the patient. But just for glycemic control hospitalization is definitely not indicated.
Thanks again, and again i'll remind you for your recent thyroid profile, and life style schedule. Regards!.
Above answer was peer-reviewed by
Follow-up: On Human mixtard coupled with Mclazide. Weight gain. Stopped Piopar and Janumet. Prescribed MclazideM with Glyciphage500. Guide? 5 hours later
Thanks for a very satisfactory reply. Now we will continue with the Delhi course of treatment and wait for few days to check its effectivity . Can u advise me the difference between Humalog 25 and Human Mistard 30 as the former had to be discontinued due to lesser effectivity . Does the latter tends to more weight gain and when it should be taken? Will the treatment with Victoza may lead me a day whin I get free from insulin injections.
Thanks n regards
Answered by Dr. Minal Mohit 11 hours later
Brief Answer:
Humalog is an analog insulin.

Detailed Answer:
Dear XXXXXXX thanks for your patience.
Humalog is an analog insulin, genetically engineered, it is rapid acting, and short lasting. The molecule is Lispro. When this lispro is protaminated it becomes protamin lispro, this is now long acting say around 8-10 hours. Humalog 25 is a premixed combination of 25% lispro and 75 % protamine lispro. it is costly but definitely better as it gives you flexibility and command over your diabetes.
Conventional regular insulin is an old conventional insulin extracted from human pancreas. It is cheaper, starts acting slowly and last for 4-6 hours, similarly NPH is a conventional long acting insulin. Mixtard 30/70, is a premixed formulation of 30% regular and 70% NPH. It is cheaper, needs to be taken 30 minutes prior to your meals.

Your doctor discontinued Humalog and switched you to mixtard , may be because he could foresee that you will be requiring a bigger dose, so the cost will rise. Weight gain is almost same with any insulin. Dose effectivity is also equal. Specific indications for analogs or humalog as you know it are
1. pregnancy
2. steroid worsened diabetes
3. irregular lifestyle
4. children
5. high profile people
6. very sick people, not sure when will they eat , how much they will eat, so analogs can be given even after the meals after seeing how much the patient has consumed.
7. affording class.

Victoza is another treatment modality of diabetes care. It is related to GLP-1 analog group. It is no way substitute for insulin and no day it will TREAT diabetes. For that matter let us make things very clear, as of now there is no cure for diabetes , we only care for it.

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