Maximum dose of Diabetic Medication and When to Start Insulin

Patient

Q: Good morning, I've been taking Metformin, Actos and Amaryl for my meds. Recently my doctor prescribed 2mg of Amaryl in the morning and 2mg in the evening. My numbers have been running around 200-550. I made the call last week to my doctor and he raised it from 2mg to 4mg twice a day. This still has not dropped my readings at all. I am scheduled to visit him again in two weeks. Is this too long for me to wait to see if the amaryl will work or should I contact him to be seen sooner.

Doctor

A:   The maximum recommended dose of Amaryl (Glimepiride) is 8mg once daily, which is what you are currently prescribed in a split dose. If your blood sugars are not controlled adequately on maximum dose of amaryl, in addition to metformin and actos (pioglitazone), I advise attending your family doctor or diabetes specialist, to ascertain why there is inadequate control and discuss further treatment options. You make require addition of low-dose insulin therapy to maintain good diabetic control and prevent future complications.

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