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Am I on right medication?

Answered by: Dr Sujeet Jha | Director,
Institute of Endocrinology, Diabetes & Metabolism,
Max Healthcare, New Delhi

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.

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.