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Which drugs are safe for diabetes?

Q: I am 55 years old and I am suffering from diabetes for the past 6 years. I am 5 feet 11 inches tall and I used to weigh 80 kg 6 years back. I was prescribed Glucored plain one tablet to be taken before breakfast and one before dinner. The sugar level was 120 (fasting) and 160 (post meal). After 4 years my sugar levels shot up to 150 (fasting) and 210 (post meal). The doctor prescribed Glypride 2 mg two tablets (before break fast and dinner) and one piozone M 15 after lunch. I have taken it upto last month, but it has not control on my sugar levels properly and my weight has reduced to 75 kg. I started taking glucored forte one before breakfast and one before dinner. Now my sugar level is 120 (fasting) and 160 (post meal). Some doctors say that Glucored is an old medicine and it is not prescribed nowadays. Should I continue with glucored forte?

A:One of the serious problems facing the people of India is the marketing of totally illegal and irrational combinations of medicines in one tablet. Nowhere in the western world does one find such combinations called fixed-dose combinations (FDC). In diabetes, it is necessary to titrate (increase or decrease) the quantity of various medicines depending on response. This can not be done in FDCs. That is why they are irrational. For example, Glycored is a combination of two medicines: glibenclamide 2.5 mg and metformin 400 mg. Glycored Forte contains 5mg of glibenclamide (i.e. double of plain Glycored) but only 25% more metformin (i.e. 500 mg instead of 400 mg of plain Glycored). Suppose you require 2.5 mg of glibenclamide twice daily and 500 mg of metformin twice daily - this cannot be done with an FDC. Besides, there are scientific trials to see how two medicines when combined in one tablet may be interacting with each other. It is difficult to understand the reasons behind your being transferred to Glypride (glimepiride) and Piozone (pioglitazone), a reserve medicine to be used only when all other conventional medicines have failed. It would have been more logical to titrate the dose of glibenclamide and metformin - two tried and tested medicines. Now you are again taking glibenclamide 5 mg twice daily and metformin 500 mg twice daily. It would be better to take them independently i.e. glibenclamide (Daonil 5 mg) morning evening and metformin (Glyciphage 500 mg) morning evening. In case at some stage in future your blood sugar goes out of control, you can at least increase Daonil 2.5 mg or 5 mg to three times daily and Glyciphage 500 mg 3 times daily or to shift to Glyciphage 850 mg twice or thrice daily by carefully titrating the dose. This is best done by the patient himself. Please also keep in mind that in the field of medicines, well tried and tested conventional drugs are safer than newer ones with which we have very little experience.

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