Q: I am a 53 years old diabetic man suffering from hypertension for the last 4 years. My blood sugar levels are not under control for the last one year. My test reports state: urine for micro albumin random – 40 mg/dl and lipid profile is: cholesterol – 150 mg/dl, HDL – 40 mg/dl, LDL – 84 mg/dl, VLDL – 26 mg/dl, triglycerides – 132 mg, fasting glucose – 141 mg/dl, urea nitrogen – 9 mg, urea – 19 mg, creatinine - 0.09 mg/dl, uric acid - 4.2 mg, sodium – 138 mmol/1, potassium - 4.2 mmol/1, chlorides – 11 mmol, calcium - 9.5 mg, total proteins - 7.0 gm/dl, albumin - 4.2 gm, globulin - 2.8 gm, albumin; globulins - 1.5:1, glycosylated haemoglobin - 7.6%, bilirubin total 0.05 mg, bilirubin direct - 0.20 mg, SGOT – 17 iu/l, SGPT - 20/iul, alp - 67/iu /l, sugar in urine is nil. Post lunch sugar levels were 241 mg/dL, 211 mg/dL and 180 mg/dl for 3 days. Now I am taking Amaryl 1 mg, Losar 50 mg, Ecosprin 150 mg, Glycomet AGM twice daily, Atorlip 10 mg, Gluco Bay 25 mg, folic acid 0.05 mg and Becosule capsule daily. Do I need to take insulin? Please advise.

A:Goals for diabetes control as per the recommendations of American Diabetes Association are as follows:

1. Pre-meal blood glucose - 70-130 mg/dl
2. Peak post meal blood glucose <180 mg/dl.
3. Glycosylated Haemoglobin (HbA1C) <7%

You are on maximum dose of Glycomet (Metformin). At this time the dose of Amaryl (glimepiride) can be increased further gradually up to a maximum dose of 8 mg/day if needed. Please consult you diabetes specialist for dose titration. Patients with type 2 diabetes of long duration can start requiring insulin at some point, which is a natural progression of the disease. Elevated microalbumin in urine can be a complication of diabetes. To prevent further worsening, a tight control of blood glucose and blood pressure is essential. Ideally medications of class Angiotensin receptor blockers (ARB) and angiotensin converting enzyme inhibitors (ACE inhibitors) are recommended for this purpose. Losartan (which you are already taking) is a medication of ARB class and is appropriate in your case. Your doctor can adjust the dose to meet the BP goals.