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diabetic Type 2

Q: Dear Doc,I am a diabetic (Type 2). Medication, workouts etc. RBS 160 Having sweet tooth. I have been using sugar substitute pills in my coffee and tea for over a year.Now I hear these are bad for the heart. Kindly advise.Thanks

A:1. The fact that you are taking Tenormin (one of the brands of a medicine called atenolol) shows that it is being given to you for high blood pressure (and/or angina; there is no mention of this in your medical history). It is very important to control blood pressure in diabetese. However atenolol can interact with anti-diabetic agents and can reduce their efficacy and/or increase the need for higher dosage. In Type 2 diabetes, it is preferable to give either enalapril (trade name: BQL 5mg-10mg 1-3 times daily depending upon response) or terazosin (brand name: Olyster 1mg daily for 7 days; then increase to 2mg daily if BP not controlled) or amlodipine (trade name: Amlodac 5mg once daily). It is best to avoid atenolol and other similar agents called beta-blockers such as propranolol, metoprolol etc - all ending with olol. . 2. Either because of taking atenolol (Tenormin) or otherwise, you are taking three anti-diabetic agents namely Dibizide-M (containing two medicines: glipizide 5mg + metformin 500mg), and Glypride (contains glimepiride 1mg). It is not clear as to when diabetes was diagnosed in your case. Since you have been taking sugar substitutes for just one year, I assume your diabetes was diagnosed recently. Whatever may be the case, fixed-dose combinations of anti-diabetics are best avoided because one cannot adjust dose according to need. For instance you are taking glipizide 5mg and metformin 500mg simply because the combination is made like this. How do we know that your correct medication is not 10mg of glipizide and 850mg of metformin? Therefore good clinical practice demands that whenever two medicines are to be taken, they should be taken as separate tablets in appropriate dose for individual patients. Such fixed-dose combinations are irrational and are not allowed to be manufactured in any developed country such as US, UK, France, Germany etc.Secondly, these days we prefer to give long-acting preparations to get 24-hour control. Assuming that you actually need glipizide 5mg; then it is better to take a long acting preparation such as Glipicontin 5mg Continus. Similarly if at all required metformin 500 or 850mg (trade names: Formin, Glyciphage, Walaphage) can be taken separately. One should certainly look at the possibility of reducing anti-diabetic medication in your case. It is not clear as to when and why glimepiride was addded. You are barely 53 years old. We have to keep at least some medicines in reserve for future use to avoid the need for insulin injections. I hope you are regularly doing brisk walk for at least 45 minutes (covering no less than 4.5km). This reduces both the need and dose of medication. 3. There are several sugar substitutes available in the market. You have not given the name but those containing aspertame such as Sugar Free are harmless and can be used over long periods without any side effect.

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