Hi XXXXXXX

Thank you for the query.

Before advising you on your mother's sugars let me tell you that the master health check up done for people by corporates does really not cover many important investigations a person with diabetes should undergo at least once a year.
The tests are HbA1c, serum creatinine, urine microalbumin, liver function tests, TSH, Lipid profile, Serum sodium and potassium, ECG, ECHO, Dilated fundoscopy, a thorough feet examination.
Most of the master health check ups do not include: HbA1c, urine microalbumin, TSH, ECHO, Dilated fundoscopy (you need to see an Ophalmologist- eye doctor- for this), feet examination.
Hence right away get these tests done not only for sugar control but also to reduce other cardiovascular, eye and foot problems' risk factors in her.

I am sure your mother's average blood sugar test- HbA1c- is more than 9% at this stage. Could you please tell if she is continuing any of the oral medications for diabetes like Glimepiride/ Gluconorm PG2 along with the insulin? If not, then she also needs addition of tablets like Metformin or combination of Metformin and one more drug combination along with slight increase in her insulin doses.
Please let me know:
- The status of her all oral medications- name, doses, frequency
- If your mom is overweight
- If she has any gastric symptoms
- If she is physically active, how
- How are her eating habits
I shall guide you what to do once you provide me with these details.

Waiting for your inputs. Take care.

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Thank you, Mr XXXXXXX for these details.
As of now please increase the dose of Tablet Clamet (Gliclazide- 80 mg and Metformin 500 mg) to 1 in the monring and 1 in the night. She does not need Glimada 2 mg at all. you can very well stop it with consultation by very good physician not her regular Diabetologist. In addition, separate metformin SR- CETAPIN XR need to be added both the times. We can postpone increase in the insulin units as of now. But kindly see your doctor for appropriate doses prescription.
Once she starts on Clamet one full tablet in the morning and one full tablet in the night plus Tab Cetapin XR one in the morning and one in the night, she should start having lesser sugar readings.
But be informed that once a person with diabetes since so many years needs insulin, he/she might also need to titrate insulin to higher doses. But all this with direct consultation. So be prepared that if the increased dose of tablets does not help, I shall recommend increase in insulin doses depending on her fasting and post meal sugars. Please monitor sugars on a meter at home- fasting 2 hours post breakfast, 2 hours post lunch and 2 hours post dinner- in a sequence as one reading one day.
Please get back to me with these readings and reports of the rest of the tests.
Take care.

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