Q: I am 54 years old with type 2 diabetes since fifteen years taking insulin as well as tablets. My recent fasting sugar level is 101 and post meal is 202. My problem relates to diabetic neuropathy i.e burning, tingling, restless feet with swelling after sitting for 3 - 4 hours in office or while travelling. The problem exists particularly in my left foot. This happens whenever dietary control is poor i.e. when I take potatoes type vegetables. I avoid sugar in tea and other sweets. My doctor advised me to take nerve up and nueropill. I am also suffering from reduced sensation in the feet and I feel I might fall. Please help. I am 98 Kg in weight and 156 cm tall.

A:Your height is given as 156 cm (i.e. 5 feet, 2 inches) and weight 98 kg. If this information is correct then you are grossly over-weight and it becomes extremely difficult to control diabetes. So the first thing is to reduce weight. Diabetes is a progressive disorder. Unless blood sugar is tightly controlled, the usual course of the disease is development of neuropathy, nephropathy (kidney impairment), retinopathy (eye problem) etc. I hope your doctor has got kidney function tests (blood urea nitrogen, serum creatinine and 24-hour protein estimation in urine) done to exclude nephropathy since it can also cause swelling. Once neuropathy develops, most unfortunately there is no way to reverse the process. One can only hope to control it so that it does not progress. The only way is to keep blood sugar under tight control. The use of medicines such as vitamins B-1, B-6, B-12 and methylcobalamin do not alter the outcome. You are taking two Fixed-Dose Combinations of such vitamins. If you compare the formula you will find that both Nervup and Neuropill are quite similar. The only difference is that Neuropill also contains gabapentin, a pain killer. Such irrational products are not permitted to be sold in any advanced country such as US, UK etc. Due to lax laws, Indian pharma manufacturers get away with totally irrational combination products which not only cost lot of money but give false hopes to patients. Patients should also be careful and ensure that only products of quality, known companies are consumed. Your attention is invited to the general notes on FDCs and selection of brands. 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.