I am using 2 mg glimepiride twice morning and night, metformin 500 mg before breakfast and istamet tab 50/500 twice a day after lunch and dinner along with 20 units of lantus insulin. My hba1c is 7.9 and reactive hyperglycemia for pp, fluctuating between 190 and 220 with fasting sugars between 100 and 110. I am 52 and lean frame of 5.8with 68 kgs. Do I need to change medication to achieve target 6.5 hba1c.

Dr. Prabhakar Laxman JatharEndocrinologist51yrs exp

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Mr Chakravarthy, Thanks for the query. I have seen the details given. You are a confirmed diabetes patient, hence after food glucose level is bound to be high. It is not reactive hyperglycemia. The reason for that possibly is the medications being taken are not helping to reduce post prandial increase in glucose. Secondly there is a need to look at your dietary intake also. You are already on multiple oral drugs plus Insulin too. Therefore, there is a need to monitor insulin dosage and glucose levels more carefully. Plus look at the dietary intake and physical activities too. Ideally in a well controlled patient FBG should be < 100 mg or closer to 100 mg, PP 150 to 170 mg & HbA1c% < 6.5%. This is in patients of your age. So you will have talk to your physican and monitor Insulin dosage. Thanks. 

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Dr. Alwin Thilak ChristopherDiabetologist7yrs exp

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Hello looking at your drug list, it infers your insulin reserve looks very low. We need to have a c peptite levels tested or any other insulin assay to confirm and qauantify it. The long acting insulin - lantus helps your fasting glucose, but it cannot act the whole day taking care of your post meal sugar the option available for u, is to add on additional bolus insulin for post meal to achieve better control.  

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Dr. Pramod Kumar SharmaEndocrinologist42yrs exp

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Add voglibose or repaglinide before food to control pp blood sugar.Discuss with your treating doctor. 

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