Q: I was detect with diabetes last year and started medication. The doctors gave me duotrol tablet to be consumed on a daily basis. After detection almost every month I have to check my sugar level and it usually is fasting under 100 and pp 120-165 which is in the normal range prescribed at the bio-chemical chart. Whenever I ask the doctor about Duotrol, he says it is a better combination. Kindly clarify how its different from other tablets like daonil etc. which are cheaper. Last time when I checked my sugar levels, the result was 98 (F) and 165 (PP) but in urine Nil (F) and +++ (PP). I could not understand why this happened. The doctor says its not important. Also, once diabetes is detected and is kept under control with medication, can we then control it with food and exercise without using medicine?

A:It is not a good clinical practice to use Fixed-Dose Combinations of two or more medicines as per statement given below: Fixed-Dose Combinations (FDCs): Medicines are discovered individually and are supposed to be taken separately. A huge number of irrational, illegal combinations of drugs are being sold in India; quite a few without mandatory approval of the Drugs Controller General, India (DCGI). Except in a few cases (such as TB medicines), it is always better to take medicines separately so that dosage can be adjusted and side effects monitored. Duotrol contains two medicines: glibenclamide 2.5mg and metformin 500mg. Since you are taking only half a tablet per 24 hours the effective intake is 1.25mg of glibenclamide and 250mg of metformin. Both are sub-therapeutic doses i.e. scientifically underdosing. Unless adequate dose is taken, the effect will be suboptimal. Glibenclamide is long acting while metformin is short acting. Its minimum effective dose is 2.5mg. A patient can be given glibenclamide once a day but metformin should be given at least twice a day with principal meals. This explains the problems of mixing two medicines in one tablet. You would probably require 2.5mg of glibenclamide (sold as Semi-Daonil) in the morning and half tablet of metformin (Glyciphage 500mg) twice daily with principal meals. The fact that your urine was +++ positive for sugar means that at some stage after meals, the blood sugar crossed at least 180 if not more. You can check urine yourself periodically by using Diastix. I hope your doctor has also advised you to undertake regular exercise such as brisk walk for 45 minutes daily to cover no less than 4.5 km. This will help to utilise excess sugar in the blood and reduce the need for aggressive medication.