Dr. Gangavati Geeta Pramod
Family Physician
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Patient's Query
Hello doctor,
I am 64 years old. My weight is 172 pounds, my height is 5 feet 4 inches. I am a patient with diabetes and blood pressure. I was taking Vylda M 50/1000 mg and Trivoglitor 1 mg twice a day for diabetes and Cilamet 10/25 once a day for blood pressure. My fasting sugar level was about 170 mg/dL and postprandial was about 180 mg/dL. For this last time, I asked the doctor for medicine to reduce my sugar level. The doctor recommended Glimepiride 2 mg twice a day. But as this medication was added, severe headaches started. So, I stopped Glimepiride 2 mg. Later I visited the doctor in the hospital, he changed medicine from earlier to the following Glimisave MV 1.3 mg- before breakfast and Corsita - M (50/500 mg) one before breakfast and one before dinner. There was no change in the medicine for blood pressure. It continues as earlier. Due to the above first two medicines my fasting sugar level increased to above 200 mg/dL and postprandial - above 285 mg/dL. Because of the above, will you please advise suitable medicines for diabetes which will keep my sugar levels under control? Thank you.
Hello,
Welcome to icliniq.com.
I read your query and I understand your concern. First I would like to know, how many days it has been since the medicines have been changed - as it takes at least a week to 10 days for new medications to properly start showing their effect. If it has been less than that, then we can wait more and test again to see how much has the change affected the sugar levels. Secondly, if it has already been enough days, then yes, sugar levels of fasting 200 mg/dL and postprandial 285 mg/dL are high and are needed to be controlled. The headache you mentioned might be due to hypoglycemia when your medication dose was increased. If it has been enough days since the start of tablet Glimisave (Glimepiride, Metformin, and Voglibose), and capsule Corsita (Sitagliptin) and you are still getting these levels of sugars, I would suggest the following. Increasing the dose of tablet Glimiperide by adding tablet Glimepiride 0.5 mg at night. This will increase the dose in the day to a total of 2 mg per day (currently you are taking 1 mg in the form of Glimisave). Please do not take this tablet with a tablet Metformin combination as it will increase your total Metformin in a day to 2000 mg, which may cause gastric issues. Consult your specialist doctor, discuss with him or her, and take the medicines with their consent. Continue with the current dosage of Glimisave MV (Glimepiride, Metformin, and Voglibose) 1.3 mg before breakfast and capsule Corsita M (Sitagliptin) 50/500 twice a day. Consult your specialist doctor, discuss with him or her, and take the medicines with their consent. Get a serum creatinine and urine routine done along with fasting sugar levels and post-prandial one month after starting this night dosage of Glimiperide. Consult your specialist doctor, discuss with him or her, and take the medicines with their consent. Please Note. Fasting sugar levels should be done after eight hours of normal sleep and within one hour of getting up in the morning. Also, you should have had a normal dinner the previous night. You may require more dosage of Glimepiride, but right now I am starting at the smallest safe dose possible as I do not know your other parameters (like serum creatinine and also how many days it has been since you started the medication.) Once you are comfortable with this dosage, we can increase it later if sugar levels are still high. It is best, to do a video consult before starting this. Please follow an appropriate diabetic diet and avoid frequent digressions. Your HbA1c level will also help in seeing your average blood sugar levels. If you have a glucometer at home, you can also test it at different times every few days and make a diary note, which will help to see the sugar level trends. Diabetes is a systemic disease and any medication is started only after seeing your overall health and not just blood sugar levels. I hope I have answered all the doubts you have. Please follow up in case you have any more doubts or queries. Regards.
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