Q: I am a 63 years old patient suffering from diabetes type 2. My Creatinine level is 3.97mg/dl, haemoglobin - 8.6 gm/dl, Echo - 61%, fasting – 38 and PP is 110. The doctor asked me to take these medicines – 20 units of human Mixtard - 30/70 in the morning before breakfast, Clopilet - before lunch every alternate day, Atorlip 10, Phostat 667 once daily, Asomax 2.5 once daily, Urimax D once daily at night, injection Engerix B i/m, Ferium XT and Folvite. The doctor has also advised me that there would be symptoms of swollen feet and mouth due to intake of aforementioned medicine. I do exercise regularly, brisk walking and restricted diet with 40 g of fish / chicken daily and am using human mixtard 30/70 for the last 10 years. Am I on right treatment?

A:Your treatment including dietary advice is in right direction except insulin. If you note your fasting glucose is only 38 which is hypoglycemia. This is due to the fact that Mixtard becomes loner acting (more than normal with increased creatinine levels). I would suggest you to either change over to Actrapid 10 units in the morning and 6 in the evening or else try with Mixtard 16 units a day only. Please note that in view of kidney failure you will need either dialysis/transplant in due course of time and you should be mentally prepared for the same. If your haemoglobin does not increase with iron then you will also need injection EPO as well.