Hello doctor, this is Dr. Vivek mishra (intern, pmch) I wanted to ask about diabetic status of my mother (45 years old) my mother is diabetic for last 5 years. She is currently on voglibose 0.2 mg + zita met 500 in morning, 1 tab ozomet vg2 before lunch, and 1 tab ozomet vg2 before dinner. Still her fasting sugar is around. 150 and pp around 240, random around 200, usually. She is also on thyrox 75 for hypothyroidism. Lipid profile is normal and balanced. Please guide for how should I manage her hypothyroidism as well as diabetes. (zita met is teneligliptin 20 mg + metformin 500 mg) (ozomet vg2 is glimepiride 2 mg, metformin 500 mg, voglibose 0.2 mg)

Dr. Pramod Kumar SharmaEndocrinologist42yrs exp

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Give ozomet vg2, before b/f and dinner. Zitamet and voglibose before lunch. If not controlled add a sglt2 inhibitor. You have not mentioned latest tsh level to suggest anything regarding hypothyroid management.  

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Dr. Prabhakar Laxman JatharEndocrinologist51yrs exp

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Hello, Vivek, Thanks for the query. I have seen the details given. From that it is clear that she is on multiple medications. However, there is no mention of herHbA1c%, weight, extent of physical activity, particularly exercises like brisk walking or any other activity plus dietary pattern . It is very essential to concentrate on following aspects - 1) weight control (BMI <23 kgs/Sq meter), 2) Taking a healthy balanced diet like - increased intake of green leafy vegetables, salads and certain fruits (orange, apples,papaya, pomegranate, pear, kwivi, guava, water melon, better to avoid mangoes, big bananas, chikkoo and grapes). I am sure you are aware in a well controlled diabetic patient FBG should be < 100 mg or closer to 100 mg, PP 150 to 170 mg & HbA1c% < 6.5%, particularly in patients below 50 years. It would have been better if you had mentioned her lipid profile values as well as BP. Because by saying "normal and balanced" there is no clarity. In diabetic patients LDL needs to be < 70 mg. Plus BP needs to be very well controlled. Instead of adding any further medication if you give a closer look at her lifestyle that is diet and exercise as well as weight control(I am not aware of any of these facts), her blood glucose can be very well brought down. Another aspect is you may consider increasing the dose of Glimiperide to 4 mg in a day. But my first attempt would on her correcting the lifestyle. I hope these things will help her. As regards hypothyroidism again there is no mention of her TSH value. I am sure you are aware it should be between 3 to 4 mU/L, to keep her free from all the symptoms.Thanks. Ed 

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