Management of diabetes not controlled by oral hypoglycemic drugs

Patient

Q: My dad is having type 2 dibetes, currently he is using galvus 50 mg once and neodipar 850 mg thrice but still the random sugar is above 250 and fasting sugar is 195 , now what medicine is to be used

Doctor

A:   The main aim in the treatment of diabetes is to achieve an A1C level of <7 percent. Glycemic control can prevent cardiovascular morbidity and minimize risks for retinopathy, nephropathy, and neuropathy. You have mentioned that your father is currently on galvus (vildagliptin) and neodipar (metformin). Failure of initial therapy with lifestyle intervention and metformin may require an additional second oral or injectable agent, including insulin.
Factors that can contribuite to worsening glycemic control are:
i) Decreased compliance with diet, exercise, or the medical regimen or weight gain.
ii) An underlying illness or an indigestion of the oral drugs.
iii) Progression of the underlying disease process including insulin resistance and deficient insulin secretion causing type 2 diabetes.
I would suggest that your father consult his doctor or preferably an endocrinologist/diabetologist to see whether insulin is warranted in his case. Insulin is a reasonable choice for initial therapy in patients who present with symptomatic or poorly controlled diabetes, and is the preferred second-line medication for patients with A1C >8.5 percent or with symptoms of hyperglycemia despite initial management with meformin and lifestyle interventions.

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