Brief Answer:
Want to know more.

Detailed Answer:
Hi,

Thanks for your question.
Noted your concern.

I want to know whether these blood sugar levels are after using medications (Exermet GM & Onglyza) regularly or these medications started after this report.

In general I may suggest -
- Regular use of medications.
- Diabetic diet : for which you should consult near by dietitian who can plan diet for you depending upon your BMI (Body Mass Index) and food habits.
- Exercise : At least 150 min per week of moderate degree physical exercise (considering normal effort tolerance) may be suggested.

Please get back to me as early as possible.

Regards,
Dr. Abhay Mali.
Diabetologist.

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Brief Answer:
I may favor insulin.

Detailed Answer:
You are already on combination of 3 good antidiabetic medications in sufficient dose.
Tab Exermet GM2 contains Glimepiride 2mg + Metformin 500mg
Tab Onglyza contain Saxagliptin.
With that your blood sugar levels are more than 200.

In such a scenario I may also favor use of insulin rather than changing oral antidiabetic medications.
We get predictable decrease in blood sugar level with use of insulin which give some relief to exhausted pancrease.

I may suggest-
- Increase dose of Metformin to 2000mg per day in divided dose, considering normal Renal function (Which can be known by serum creatinine and Glomerular Filtration Rate) and Heart function.
- Continue Tab Onglyza 5 mg once a day as before.
- May reduce dose of Glimepiride to 2 mg per day in divided dose.
- And addition of daily single dose of long acting insulin (Insulin Glargine) at night.

With this regime I may suggest to monitor fasting blood sugar with home glucometer alternate day (if possible) and accordingly may increase dose of Glargine.
Otherwise repeat fasting and post-prandial after 8 to 10 days and modify the dose of insulin glargine.

It may be possible after achieving good blood sugar control with above regimen one can gradually decrease the dose of insulin and may be knock it off.

Keep following regular exercise and modify diet as advised earlier.

Insulin is nothing but what is deficient in diabetes, we are providing it in ready made form without any harmful effects.

Hope this helps you.

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Brief Answer:
Termination of action of drugs and hepatic glucose output may be the cause.

Detailed Answer:
Type 2 diabetes is associated with insulin resistance.
In insulin resistance there is increased insulin requirement by body because body tissues do not respond to insulin action..
During fasting state our body requirement of glucose is full filled by glucose production by liver called as hepatic glucose output.
Hepatic glucose output is regulated by insulin.
Due to insulin resistance there is excessive production of glucose by liver which is independent of food intake.
Because of that there is fluctuation in blood sugar level causing increased fasting blood sugar level as compared to bed time sugar level.

Also decreased action of anti diabetic medications after particular time also responsible for delayed increase in blood sugar level.

Hope this helps you.

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