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Am I on right medication?

Q: I am a 45-year-old male weighing 115 kg and height 165 cm. I am an insulin-dependent type-1 diabetic. I am taking the following medicines as prescribed by the doctor: Mixtard Humilin-30 daily morning and evening before meals; and Glucobay 50, Glycheck -M 80 (Glicalzide and Metformin hydrochloride, Fibator (Atorvastatin and Fenofibrate)and Valent-H, Nebicard -5 twice daily before meals. After taking all the above medications, my normal BP is 140/90, on fasting it is 180 and PP sugar is 260. My serum creatinine is 1.1. Microalbumin is positive. Do I need to change the type of insulin and the other medicines that I am taking? My lipid profile is normal. Do I need to consult a Nephrologist to get some more tests done as a precautionary measure for my kidneys? I take a pure vegetarian diet and do not indulge in alcohol or smoking.

A:

  • Your sugar control is not optimal and you should get your HbA1c done, which will give you an average sugar control test over a period of three months. It will be high, and your dosage of Glizid M can be increased. Or you would benefit from a higher dose of Metformin (1 gm twice a day). Discuss this with your doctor and later Glicalzide can also be increased to a higher dose (maximum dose 320 mg in a day). It becomes difficult to adjust the dosages of medications in combination.
  • In view of microalbumin positive and high blood pressure, target BP would be 125/75 to protect your kidneys from damage. Your blood pressure medication needs adjustment to achieve target blood pressure control.
  • You should take a small dose of Aspirin (Ecosprin 75 mg) to prevent heart disease and stroke.
  • Your creatinine is 1.1 with positive microalbumin. An Endocrinologist / Diabetologist would be able to control your blood pressure and monitor microalbumin levels, otherwise you can visit a Nephrologist. Please discuss with your doctor before you change your medication.

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