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Do I need insulin to manage my diabetes?

Q: I am aged 59 years old. I have diabetes from the past 20 years. I have been using tablets Diabetral-2 daily in the morning and evening, Pioglar 45 mg daily once and Glycephage one daily. My blood sugar levels stands at 120 mg fasting and 180 mg post meal (2 hours). Is it necessary to go for insulin? I am suffering from knee pain from the past few days and am using Ebov 60 once daily.

A:If the information given by you is correct, then you are consuming one medicine (metformin) twice. Glyciphage is a brand name and contains metformin (500mg and 850 mg). Diabetrol is a Fixed-Dose Combination of glibenclamide 5mg and metformin 500mg. It is incorrect to give the same medicine twice in two different formulations. Pioglar is the brand name; it contains pioglitazone. Pioglitazone is given only when the diabetes is not under control with maximal doses of glibenclamide (15 mg daily - you are taking 10 mg daily) and metformin (Glyciphage 850 mg three times daily). In other words if a patient is taking glibenclamide (Daonil) 5mg with all the meals breakfast, lunch and dinner) along with metformin (Glyciphage 850 mg) three times daily and the blood sugar is till not under control, then pioglitazone (Glizone) can be added starting with 15 mg once daily and increasing to 30 mg and then to 45mg once daily. If still the blood sugar is not under control, then it may be necessary to shift to insulin and metformin. Needless to say diet control and exercise are integral part of the management of diabetes. Without them even insulin can fail to control the disease. I hope you are doing brisk walk daily for at least 45 minutes so as to cover 4.5 km or more. With regard to your knee problem, it could be a complication of diabetes or independent of it. It should be investigated and diagnosed. Ebove 60 does not appear on the national and international data bank of quality medicines. Hence I am unable to comment on it. Please see general statements on FDCs and brands below. General statement on selection of brands: There are scores, sometimes hundreds, of brands of the same medicine. Against about 300 pharmaceutical manufacturers in western countries like Britain, there are over 20,000 producers in India that market more than 40,000 brands. Most manufacturers do not have quality testing laboratories. Hence selection of brands is important. Many companies give incentives to prescribers to patronise their products. Patients should check the reputation of manufacturers before consuming medicines. 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.

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