Is my treatment for diabetes correct?

Q: I am a 35 years old diabetic male taking these medicine from the past two and a half years – one Zoryl MP in the morning before breakfast, Diabevit capsules in the afternoon, Pioz MF-15 before the dinner and TG-TOR EZ after 30 minutes of the dinner. My latest Hb1Ac is 8.6 mm/dl. Am I taking correct medicines?

A:Zoryl MP-1 contains glimepiride + pioglitazone + metformin. Pioz-MF contains pioglitazone + metformin. TG-TOR EZ contains atorvastatin + ezetimibe. Diabevit contains sub-therapeutic (hence of little value) doses of certain vitamins and minerals. It is always better to take medicines individually rather than 2-in-one or 3-in-one products because doses of individual medicines can not be adjusted. In your case for example you are taking glimepride 1mg a day (normal dose range is 1-4mg a day; maximum 6mg a day); piogltazone 15mg + 15mg daily = 30mg (normal dose up to 45mg daily, if required) and metformin 500mg + 500mg = 1000mg (normal dose range 500 to 2550mg daily). Suppose you actually need glimepiride 2mg daily + pioglitazone 45mg + metformin 1500mg. Such a dosage is not possible with combination products but very easily done with individual medicines consumed separately. In any case your blood sugar control as determined by HB1Ac is not within acceptable limits. Hence your treatment needs review. You have not given the tests for lipids (such as cholesterol, triglycerides etc.) even though you are taking TG-Tor EZ. Please keep in mind that unless your blood glucose levels are brought down, lipids will remain erratic and high; hence the answer lies in tighter blood sugar control not taking additional medicines to force lipid levels down. Both atorvastatin and ezetimibe (constituents of TG-Tor EZ) have many side effects such as muscle toxicity (myopathy and rhabdomyolysis which is pretty serious) etc. Hence such drugs need to be taken only when there is clear, clinical need, that too separately in caliberated doses.