Q: My relative is 42 years old. He was diagnosed with diabetes three years back. He is taking oral drug Glipizide 250 mg twice a day. For the past three months, his sugar level is not under control. The fasting sugar level was 168 mg/dl three months back but shot up to 204 mg/dl few days back. We are asking him to go for insulin injections. Is it safe to take insulin injections at his age? Are there any side effects of taking insulin? Also, will he be able to lead a normal life after taking these injections, i.e. will his sugar level become normal? Kindly let us know the brands under which insulin is available and the amount of insulin that he should take. And lastly, can he revert to taking oral drugs after his sugar level is controlled?

A:Your relative has type 2 diabetes mellitus (DM). Most importantly, one has to keep in mind while treating DM is glucose control, which means keeping FBG <130 mg/dl and PPBG <160 mg/dl. Another test that which can be done to assess glycaemic control is HBA1c levels, which tells glucose control in last three months. The target value for this test is <7. The primary issue is to get these targets, and how one gets these is secondary. Options to treat and get these targets are oral medications either as single agent or in combination or insulin alone or in combination with oral medications. Insulin can be given at any age and has no harmful effects as it is a normal requirement of the body and many of oral medications act by increasing insulin in our body. Options of insulin are either premixed twice daily or oral medication with basal 24 hours acting insulin like glargine (Lantus) or Insulin Detimir (Levimir). In case of your relative, it is not clear what dose and medication he is taking. In case only one medication is being taken, then it is better to use other medications in combination. In case insulin needs to be used, which can be done harmlessly, start with Levimir or Lantus 0.2 units/kg per day once a day and uptitrate according to glucose readings at home using a glucometer. Once blood glucose is controlled, one can give a trial of oral medications alone again, and it is possible that patient can do without insulin for some time.