Q: I am a 54 years old man having Type II borderline diabetes for the last 4 years. I also have mild hypertension. I take 500 mg Metformin twice a day. My readings on glucometer are between 110 to 180 mg% and HbA1c varies between 6.2 to 8.5. My random reading throughout the day is less than my fasting level. This is observed on a regular basis. Usually I record fasting around 135 mg whereas on many occasions in the evening, after some walk and exercise, before dinner I get a reading at 110 mg%. What is the explanation? Do I need to take any additional medicine?

A:High fasting blood glucose is one of the earliest problems in type 2 diabetes, so your problem is not unusual. You may try delaying your evening dose of metformin to bedtime and see if that works. Also given that your HbA1c has been as high as 8.5, maybe you do need to increase your dose, but you should do that after discussing with your doctor. With sugars going upto 180, and HbA1c of upto 8.5, I am not sure on what basis you think of your diabetes as borderline! Like all diabetics, you need to:

1. try and avoid getting overweight,
2. make sure your BP stays at or under 120/80, and
3. monitor at least annually

• lipid levels,
• retinal changes,
• microalbuminuria,
• ECG, etc., because you do have diabetes.