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Suggest ways to reduce Hba1c levels

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Posted on Wed, 18 May 2016
Question: Hi I am XXXX XXXXXXX 58 yrs I have two tablets one Cetapin -500 after lunch & Janumet -50-500 after dinner still my sugar levels are 140 Fasting & 200-220 Post meal . Walking for 40 minutes is regular exercise Last Hba1c was 7.3 --- I want reduce my Hba1c to 6 pl suggest
doctor
Answered by Dr. Abhay A Mali (24 minutes later)
Brief Answer:
You need modification of dose of Anti-diabetic medicines.

Detailed Answer:
Hi Mr. XXXX,

Thanks for your question.
Noted your concern.

Type 2 diabetes is due to combination of Insulin resistance (increased insulin requirement of body) & Defect in pancreatic insulin secretion.
As age and duration of diabetes advances there is progressive deterioration of insulin secretion by pancreas without much change in insulin resistance.
That's why as age and duration of diabetes advances patient requires increased doses of same medicines (medicines which are sufficient to maintain blood sugar level within limits previously) or addition of newer medicine to control blood sugar level.

It may be difficult to reduce HbA1c from 7.3 to 6.
You can target HbA1C of less than 7 in next 4 to 6 months

In such a case I may suggest to increase the dose of Metformin to 1.5 - 2 gram per day in divided dose along with increasing the dose of Sitagliptin to 100 mg per day considering normal kidney and heart function.
ie. Tab Janumet (Sitagliptin 50 mg + Metformin 500 mg) twice a day &
Tab Citapin (Metformin 500 mg) once a day.
And may suggest to recheck fasting and post-prandial blood sugar level after 2 to 3 weeks and further changes if needed depending upon blood sugar readings can be done.

You should discuss all these changes with your treating diabetologist as kidney, liver & heart function need to be known.

Along with this continue following regular exercise and diabetic diet.

Hope this helps you.

Regards,
Dr. Abhay Mali.
Diabetologist.
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Abhay A Mali (4 hours later)
Diabetes was detected in 2005 & I was not knowing anything about it . Hba1c was first tested in 2009 & was 8.5 with cetapin 500 gm two tablets /day. Janumet 50/500 he added & I started swimming in six months it was reduced to 6.6 & then to 5.2 . It was then around 5.2 to 6.6.With same medication. Is it not possible now ?
doctor
Answered by Dr. Abhay A Mali (52 minutes later)
Brief Answer:
It may be possible but need to take appropriate efforts.

Detailed Answer:
Hi..
Welcome back.
Thanks for follow up query.

With 10 years of diabetes one cannot predict the final HbA1c level right now.

First we need to target your fasting (below 120) and post-prandial blood sugar (below 180).
Once Fasting & Post-prandial blood sugar levels controlled there is very good possibility of good reduction in HbA1c level. But one cannot predict the exact level.
Instead of thinking about final HbA1c level it will be better to work on gradual betterment of test results.

Along with diabetes control there is a need for screening for diabetic complications.
- Diabetic retinopathy- Need fundoscopy.
- Diabetic foot examination for neuropathy and vascular problems.
- Renal function test and urine albumin creatinine ration for diabetic nephropathy.

Also check your blood pressure and Lipid profile.

Hope this helps you.

Above answer was peer-reviewed by : Dr. Deepak
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Answered by
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Dr. Abhay A Mali

Diabetologist

Practicing since :2006

Answered : 806 Questions

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Suggest ways to reduce Hba1c levels

Brief Answer: You need modification of dose of Anti-diabetic medicines. Detailed Answer: Hi Mr. XXXX, Thanks for your question. Noted your concern. Type 2 diabetes is due to combination of Insulin resistance (increased insulin requirement of body) & Defect in pancreatic insulin secretion. As age and duration of diabetes advances there is progressive deterioration of insulin secretion by pancreas without much change in insulin resistance. That's why as age and duration of diabetes advances patient requires increased doses of same medicines (medicines which are sufficient to maintain blood sugar level within limits previously) or addition of newer medicine to control blood sugar level. It may be difficult to reduce HbA1c from 7.3 to 6. You can target HbA1C of less than 7 in next 4 to 6 months In such a case I may suggest to increase the dose of Metformin to 1.5 - 2 gram per day in divided dose along with increasing the dose of Sitagliptin to 100 mg per day considering normal kidney and heart function. ie. Tab Janumet (Sitagliptin 50 mg + Metformin 500 mg) twice a day & Tab Citapin (Metformin 500 mg) once a day. And may suggest to recheck fasting and post-prandial blood sugar level after 2 to 3 weeks and further changes if needed depending upon blood sugar readings can be done. You should discuss all these changes with your treating diabetologist as kidney, liver & heart function need to be known. Along with this continue following regular exercise and diabetic diet. Hope this helps you. Regards, Dr. Abhay Mali. Diabetologist.