Uncontrolled PPBS

So this male patient who had presented with uncontrolled PPBS was put on following medicines and removed glargine insulin - Tab Gliclazide 60XR + Metformin 500mg 1 tab morning and half tablet dinner time, Tab Tenegliptin20 + Metformin 500 at bedtime, Tab Voglibose 0.3 mg with lunch Management Concern is that after four days of above medicines - His FBS is around 110/120 PPBS is around 205/203/175 Kindly guide me for treatment of this patient

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Low fasting blood sugar and high post lunch blood sugar is characteristic of sulphonylurea group of medication If dose of antidiabetic medication is increased they will have hypoglycemia. This puts limits on achieving optimum control of blood sugar Adv Remove Sulphonylurea from prescription Replace it with either SGLT2 Inhibitor or Glargine insulin

Sir, can you please let me know the age and weight of the patient
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Usually those who have PPHG require Voglibose to be taken before each meal. But here he is advised to take before lunchtime for which he may be having high PPBS.

Sir, already taking voglibose with lunch, and nowI added to dinner too and shifted Tenegliptin20 +Metformin500 to lunch time
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In your regime i will replace teneligliptin with vildagliptin and just see the results

Sir, I didnt Vildagliptin due to pill burden as it is dosed BD
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NEED'S.. REGULAR EXERCISE.. DIET PLAN.. ENDOCRINOLOGIST OPINION..

Tnx Dr Anil Gangani
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Metformin 500 mg at dinner with Gliclazide60 xR

Thank you doctor
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Sir PPBS 175 is acceptable if pt is older in age. I would advise dietary changes.. If still perisistent hyperglycemia then metformin can be increased to 2250 mg depending on eGFR If still not controlled then it is OHA failure and pt needs to be put back on Basal Plus regimen with glargine and metformin Also please check HbA1c levels as well as if the pt has catabolic features like polyurea, wt loss...either HbA1C is >9% or catabolic features present then pt needs insulin irrespective of OHA doses...since u said that the pt has affordability issues I would advise changing from glargine to simply NPH and OHA regimen

Thank you doctor
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hridyarnav ras+akik pishti+sutshekhar sada+praval panchamrit ras+yakuti ras+arjun tvak churna+

Did you check hiscHb1AC. And what is his lunch menu. Alter it with food with low glycemic index

Thank you doctor
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in Ayurveda, Jambvadi churan 1 teaspoon bd Mamejca ghan tav 2bd Galo ghan tab 1bd

Better to prescribe teneligliptin at morning time..it controls PPBS of all 3 major meals and increase the dose of gliclazide to 80 mg

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