Suggest ways to control blood sugar levels
You can change to oral medications + Lantus
Welcome to HCM. I have gone through the question and understand your concerns.
Your Hba1c currently is well controlled. You can switch to oral medications. It is better to keep Lantus along with oral medications as that will prevent worsening of blood sugars. You can safely stop Apidra.
Ideal option to start with is :
Tab Amaryl M1 before breakfast
Tab Janumet 50/500 after breakfast and after dinner ( That is the dose of Janumet irrespective of your sugar values)
Inj Lantus 10 u s/c at bedtime.
With this treatment the fasting sugars should be maintained between 80-130 mg/dl by adjusting the Lantus dose.
If your post prandial sugars (PPBS) and HbA1c go up with this treatment, you need to increase the dose of Amaryl M1 to twice daily.
Hope I have answered your questions. If you have any further queries I will be happy to help you.
Dr Ajish TP [MD,DM]
Thanks for your repy. I have the following querries:
1. Can I replace Janumet 50/500 with Jalra 50/500 as the former is very expensive?
2. Is there a way to stop Lantus also? Can there be a oral medication for basal insulin level?
3. My diabetic friends are prescribed medicines like ADvog (voglibose), EUrepa (Repaglinide) and tradgenta and they are getting results. what is your opinion on these recent medications.
Oral medication earlier has induced acid reflux in me, which got stopped after I started taking insulin. Your suggestion in this regard?
See detailed answer
Welcome back. The answers to your questions are
1. Jalra M can be replaced for Janumet with same effect. Both are same group of medicines ( Sitagliptin and Vildaglipin) with same effect on reducing blood sugars and similar side effects
2. There are no oral medications as a substitute to insulin. It is better to keep a basal insulin ( not a must in treatment)
3. Trajenta is linagliptin ( similar to Sitagliptin and Vildaglipin). It can be used as a replacement to Jalra or Januvia with similar effects. Only advantage in Trajenta is that same dose can be given in patients with kidney or liver disease, while dose of Sitagliptin and Vildaglipin has to be adjusted in these situations.
Voglibose and Repaglinide are old medications. Voglibose decrease the blood glucose after a meal - side effect is gastritis. Repaglinide is similar action to Glimepiride ( Amaryl) - only advantage is it can be used in patients with kidney disease.
So Trajenta and Eurepa are similar to Janumet and Amaryl that you are taking at present. Voglibose 0.2 or 0.3 mg can be added to treatment if your after food blood glucose are difficult to control, but it will increase the gastric reflux.
Stick on to Amaryl + Metformin + Jalra + Lantus as of now till the HbA1c is below 7%. Stop insulin after that if you are not comfortable with injections. Follow up A1c - if slight increase : increase the dose of Amaryl or add Voglibose.
If A1c is still under control stop Jalra.
Diet modifications- with frequent small quantities of low calorie high fibre diet and regular aerobic exercise can help you with reducing these medicines.
Dr Ajish TP
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