An average glucose in the mid 200s mg/dL would suggest poor control. I do not use glimepiride or related drugs which are called sulfonylureas. These drugs lead to an increased apoptosis (cell death) of the beta (insulin producing) cells of the pancreas leading to premature beta cell pancreatic failure leading to insulin earlier than might otherwise be required. The dosage of your metformin hydrochloride should be maximized at 850 mg 3 times daily. The dosage of sitagliptin phosphate (Januvia) should be maximized at 100 mg daily. Sitagliptin by the way is a once daily drug. There is no medical or pharmacological reason to take it twice daily. I would add pioglitazone (Actos) up to a dosage of 45 mg daily. It is true that the related thiazolidinedione rosiglitazone (Avandia) is being voluntarily withdrawn from the marketplace but pioglitazone is not associated with similar problems. If this does not work the next step is indeed insulin. By 10 years of diagnosis the majority of type 2 diabetics are on insulin and drugs such as glimepiride may predispose people to insulin sooner. The medical literature suggests that a basal analog insulin should be added 1st and these include detemir (Levemir) and glargine (Lantus). The medical literature however has not answered the question what to do with the oral medications once a person begins on insulin. My approach is to gradually withdraw the oral medications as I add a bolus insulin to the basal insulin. There 3 bolus analog insulin formulations which are available are aspart (NovoLog), glulisine (Apidra), and lispro (Humalog). There are 2 combination basal / bolus analog forms of insulin but I do not approve of these. Insulin in a motivated patient with a competent physician essentially always leads to proper diabetic control. If I may be of further assistance please let me know. I wish you the very best of health and happiness and in all things may God bless. JR
Health For More » Diseases and Conditions » Diabetes
My blood sugar won't drop. I am going to the Dr. on Friday. I started to see a specialist.?
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Posted 1 year ago #
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I like you hate needles,(terrified of them) but you do what you have to do to be healthy,when I was not on the needle and like you worked hard walked to work worked out and all,What did help me ,Going to sound crazy,but I used to eat cabbage cooked in a crock pot with sauce and a little chicken,and sometimes beef or sausage and I do not know how or why but it helped me and at that time in my life my Diabetes dropped,I ate it every other day because I love cabbage too and I love it with tomato sauce so that part was easy,and at that time I was not taking a needle,I need to get better control of my Diabetes today,I have not been taking my numbers and my wife is on me about this so I made an appointment to get my numbers down and get myself checked out.
Posted 1 year ago #
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