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Diabetic, on repaglinide, sugar levels are still the same. What can be done?

my mother around 60 years is diabetic & was on with 4mg of glimipride & 1000mg of metformin daily. Her FBS was 210, PPBS 450. Now she was changed to repaglinide 2mg before every meals and with 1000mg of metformin daily. she does not take glimipride now. But her sugar levels are still the same. is their a requirement of increasing the dose of repaglinide. Kindly suggest
Asked On : Thu, 28 Mar 2013
Answers:  3 Views:  38
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Internal Medicine Specialist 's  Response
Welcome to HCM,
Your mother is diabetic and on oral hypoglycaemic drugs, I presume she must be having diabetes for few years now,her blood sugar is not controlled at all.
Please visit a good Physician or Endocrinologist and if there is need please hospitalize her for control of diabetes as there is secondary failure of oral drugs she will need to control blood sugar with Insulin injection therapy.Just increasing the dose or changing oral drug will not help in such case.Yes it is possible to use insulin and oral drug simultaneously to have good result.
If she is not taking care of diet she should take diet as advised and investigate for presence of any infection.
Once her sugar is controlled then she must walk daily to increase physical activity.
There are very good Basal insulin and pre mixed insulin which can be prescribed to her, she can also do a carbohydrate count in diet and adjust dose of insulin accordingly.
Take care
Good Luck
Answered: Fri, 29 Mar 2013
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Internal Medicine Specialist Dr. Maruti Karale's  Response

Thanks for writing to HCM.

Yes,she needs dose adjustment and even may require third anti-diabetic drug if not controlled with 2 drugs.

The recommended dose range for repaglinide is 0.5 mg to 4 mg preprandially up to four times daily. Dosage adjustments should be determined by blood glucose response. The dose can be adjusted up to 4 mg until a satisfactory blood glucose response is achieved. At least one week should elapse after each dose adjustment to assess the patient's response. The maximum recommended daily dose of repaglinide is 16 mg.

Even metformin dose can also be increased up to 2 gm per day.

Get other investigations done for prevention and treatment of complications of diabetes.

Hope this could help you.

Wish your mom good health.

Answered: Fri, 29 Mar 2013
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General & Family Physician Dr. Gopal Krishnam Raju's  Response
better to shift to insulin otherwise her systems might be get destroyed :)
Answered: Fri, 29 Mar 2013
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