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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest additional diabetes treatment plan to keep the blood sugar level under control

Answered by
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Dr. Saumya Mittal

Diabetologist

Practicing since :2004

Answered : 2854 Questions

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Posted on Thu, 26 Jul 2018 in Diabetes
Question: My mom has sugar for past 10 yrs approx. She is on Regular Medication. Her sugar level generally remains FBS - 150 - 170 mg/dl, PPBS - 230- 250 mg/dl

Her HbA1C was 9.1 when tested in July'2017 and 8.5 In Jan'18. It is not reducing.

Please let me know if there is any thing in addition that needs to be done
doctor
Answered by Dr. Saumya Mittal 17 minutes later
Brief Answer:
need more information

Detailed Answer:
Hello XXXXXXX
I am Dr Mittal.
I have read your message.

First and foremost, HbA1C is reducing-
July 2017- 9.1 XXXXXXX 2018- 8.5
Considering that the normal range is at 6 there is a definite improvement of 0.7 points in the HbA1C over 6 months.

Having said that, FBS and PPBS remain a little high and there is scope for improvement.

I will need the following details-
1. When was the sugar last tested?
2. When do you test PPBS? How much time after meal? FBS and PPBS tested across breakfast?
3. What is her diet pattern and food preferences?
4. What is her exercise regime?
5. What is the medications schedule she is on?

Please let me know the above information and I will try to help you further.
Best wishes.
Dr Mittal
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Saumya Mittal 53 minutes later
Hello Dr. Mittal,

Please find below details as required:

1. When was the sugar last tested? - 10 days back.
2. When do you test PPBS? How much time after meal? FBS and PPBS tested across breakfast? - PPBS was not done recently when FBS was done. PPBS we do generally around 2 hours post lunch
3. What is her diet pattern and food preferences? - Diet pattern is normal regular home made food- Gujarati food (it is not very spicy, oily), its is normal proportion
4. What is her exercise regime? - I take her for walks during weekdays, say average 4-5 kms within a week
5. What is the medications schedule she is on?

She is currently taking following medicines:

Morning Empty stomach - Thyronorm and Glycinorm 40/500
Morning- HTN Medicine - Telsite H 40 (Irregular)
Before Lunch - Tenepride 20
Evening before dinner - Glycinorm 40/500
After dinner before sleep - Ecosprin AV 75

Hope this information helps
doctor
Answered by Dr. Saumya Mittal 31 minutes later
Brief Answer:
Suggestions

Detailed Answer:
Hello.
Thanks for the response.

First, prefer 2 take sugars half hour before and 2 hours after the same meal. It gives a better idea, since the proportions of meals taken differ in each diet- breakfast/lunch/dinner. Besides, one has a tendency to take tea and a mild snack in between meals which will add up to calory intake.

Second, since her diet pattern is normal in normal proportions, I would recommend eating in diabetic proportions- the sugar that one sees on testing is a balance between the oral intake of food and output (exercise and medications). So a diabetic proportion would be better. Since you have not mentioned the exact diet plan she follows, I cannot recommend a diabetic diet modification.

Third, a regular exercise regime is important. If it is feasible for her, the exercise schedule can be increased. Of course, she needs to be comfortable. But as I said, the sugar is a balance.

Last, I think her medicine dosage can be increased. Having said that, one needs to be careful that the medicine is increased gradually so as not to cause a fall of sugars, especially as she is taking a medicine at night that is known to cause hypoglycemia. I would recommend adding a dose of Metformin 500 mg at lunch time with Tenepride. The dose will need to be increased gradually, because of the risk of hypoglycemia.
I recommend making the change in medications only after meeting her regular diabetician.

I have tried to make it simple.
I hope these suggestions help you.
Best of luck, Dr Mittal
Above answer was peer-reviewed by : Dr. Kampana
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