OHA or Insulin?

My father, 60 yrs old, diabetic since last 15 yrs, well controlled blood sugar level till 6 month back with tab Geminor MP2 ... BD. but since last 6 month his sugar level has become uncontrollable... So Insulin was started( novapen 30:70)..1 month back.. Gradually dose was increased upto 20 morning and 18 evening.. But 10 days back he developed severe hypoglycemia... There after insulin was stopped.. And again tab Geminor MP2 is started at BD dose.. But now also sugar is not controlled. (FBS-around 170, PPBS -around 250).so plz suggest next line of treatment. Plz.

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Usually reserve insulin for patients not controlled on orals. Firstly patient is not on metformin??? Any adverse effects or never tried. Secondly consider SGLT-2 inhibitors if he doesn’t have peripheral vascular disease and no recurrent UTI. These are oral and have shown cardiac and renal benefit. GLP-1 analogs are also good especially for cardiac and weight loss, but are injectable. Non of the three above meds will cause hypoglycemia.

Yes he is on geminor mp2(Glimepride 2 mg+metformin 500+pioglitazone15 mg) bd. But not controlled. Fbs around 170 , PPBS around 250.
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First of All Do HBA1C, CXR Peptide, Anti GAD Antibodies, Lipid Profile, Start Tab Sitagliptin50/Metformin 500 (Janumet 50/500) BBF

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Start him on basal insulin like glargine at bedtime, start with 8 units at 10pm. Add him on Vildagliptin plus Metformin 50/500 twice daily, plus Tab. Gliclazide 60mg XR 15 mins before breakfast Titrate the basal insulin dose to target as per Be-Smart recommendations of Insulin titration

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Voglibose 0.3mg.15mints before dinner

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