My mother is diabetic and her gfr is around 45 ml/min. She's taking glipizide 10 mg od and metformin 500 + teneligliptin 20 mg od for diabetes. But blood sugar is not controlled properly (fasting ranges from 100-150 and pp sugar ranges from 200-300). Please suggest anti-diabetic treatment with at least some explanation.

Dr. Prabhakar Laxman JatharEndocrinologist52yrs exp

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lybrate-user. , thanks for the query. Doctor, I have seen the details mentioned. However, there is no mention of her age, which is quite important. Egfr is 45 ml/minute means there is some compromise in her kidney function. Please let me know her serum creatinine and urea. Since she is already on metformin 500 mg, (which is usually discontinued if egfr goes < 45 ml or no additional metformin is added. She is already on 10 mg of glipizide, metformin 500 mg & tenelegliptin. So we will have to look at her dietary intake and extent of daily exercise closely. Looking at her height & weight her bmi (body mass index) is 29.31 kgs/sq meter (normal <23 kgs/sq meter), which means she is already in grade 1 obesity with an excess of 14 kgs plus. So there is a need to look at reducing the weight and her dietary intake has to be matching to her ideal body weight that is 54 kg (34 x20 calories = 1080 kcals/day. As regards the drugs, we will have look at sglt-2 inhibitors like dapagliflozin or canagliflozin which will not only reduce the glucose but will also help in weight reduction. Or else insulin like glargine a long acting analogue about 6 to 10 units can be given at bed time along with her present treatment. If you have any questions please do come back. I am sure you are aware that in a well controlled diabetes person fbg should be < 100 mg or closer to1 00 mg, pp 150 to 170 mg & hba1c% < 6,5% if patient is below 60 years and < 7% in patients above that age. Thanks. 

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