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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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High blood sugar, type two diabetes. Taking triglimisave, metformin, jalra. Dosage of medication?

sir MY bood sugar fasting is 291 and pp is 400 and my doctor prescribed following medicines as I have been diagnosed Diabetic type 2 (1)Triglimisave 1 contains glimepiride 1mg, Metformin 500mg, Pioglitazone 15mg---half tablet perday (2) Jalra 50mg contains Vildagliptin one tablet per day Please advise about dose and medicines whether these are adequate and what precaution should I take Thanx
Fri, 21 Sep 2012
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Diabetologist 's  Response
Hi.



To answer to your question I would need to know how long you are having diabetes since? And what is your age?

If it is recently diagnosed, then this should be fine, though very honestly this is not a regime we follow as a standard. For a person with such a high sugars detected newly, we like to treat with short course of insulin- to preserve insulin secreting cells of the body- say for two to four weeks. After stabilizing the sugars till say 200 mg/dl or so we start on oral medications mainly only glimepiride and metformin combination and never all four- metformin/ glimipiride/ pioglitazone/ vildagliptin- together.

And if you are having long standing diabetes then this regime is no way going to help you with such high readings of sugars. You will need higher doses of these medications. Jalra and piglitazone can be kept on hold and used if optimum doses of glimepiride and metformin are not able to control the sugars. For your information, upto 6 to 8 mg of Glimepiride/day and upto 2500 mg of metformin/day are the doses that can be tried in a person who tolerates the medications well without any obvious side effects. So you are given very very less doses of those primary medications which are not going to get help by the pioglitazone part or Jalra part of your prescription. So please consult a good Endocrinologist or Diabetologist to prevent such multi-medication prescription unless wanrranted, which in your case cannot be...And most importantly, the doses of glimepiride and metformin when used optimally, should divided for a day.



I hope this give you an idea. Take care.

- Dr Madhuri
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