My mother is a diabetic patient (20 years). He has coronary artery disease. She take human mixtard 40 unit, azulix 4 mf forte, voglitor md 0. 3 at morning and 28 unit insulin, azulix 4 mf forte at night. Yesterday morning (3 am) she sweating her sugar level just 38. I give her glucose, after 15 minutes sugar level was 70. At 8 am sugar level drop again 58. I stop insulin and medicine. We went to doctor and he stop sugar medicines for 3 days. But after stop medicine sugar level going high. We check randomly every 5 hours 300 (6 pm,) 308 (11 pm yesterday, today 267 (5 am,) 386 (10 am.) what should I do?

Dr. Prabhakar Laxman JatharEndocrinologist48yrs exp

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Hello, thanks for the query. I have seen the details mentioned. Developing hypoglycemia in a patient with conventional insulin is fairly common seen problem. Plus if patient is also on glimiperide in addition to insulin, then there are greater chances. Since she was on 40 you + 28 u) two doses of insulin with 8 mg of glimiperide, the possibility was more. Usually giving more than 4 mg of glimiperide a day does not really help. However, she was on 8 mg, which is too high. In addition there were other drugs too like metformin and voglibose. These directly do not cause hypo, but can contribute if that does develop. Stopping the treatment is not the answer at all. She needs to be on treatment. Following are my suggestions: 1) it is better to switch on to a long acting analogue insulin like glargine or degludec once a day, plus a short acting insulin in the afternoon before lunch, to prevent post lunch hyperglycemia. 2) reduce the dosage of glimiperide to 4 mg or less pper day along with metformin. 3) in stead of voglibose a dpp -iv inhibitor like tenelegliptin or vildagliptin may be added for better control. 4) give a closer look at patients diet pattern and extent of physical exercise. If you have any questions please do come back. Please understand regular treatment is a must to prevent long term complications of diabetes. Thanks.  

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