High fasting sugar level

[Avantika]

my father has had diabetes for almost 6 to 7 years now he has been on janumet 50/500 and it worked fine until recently his sugar levels even with fastimng and taking propoer food and medication doesnt come below 180 fasting. he is 73 and is on cholestrol medicines pls suggest what can be done to lower his sugar?

[velkumar]

intensivedietarymanagement....

ask him to go for intermittent fasting.

[Hidden]

Carbohydrate control is the best way

Reduce it and increase proteins and good fats

Proteins are Paneer. Cheese. Eggs. All non veg. Nuts .

Good fats are: Ghee. Butter. Vco -Virgin coconut oil for cooking.

Reduce grains . Stop sugar totally and use stevia drops which are available online.

Reduce fruits to just one small serving in the evening on empty stomach.

Choose only berries and a very small qty of pomegranate

No root veggies like potato. Beets. Carrots. No banana .. both ripe and unripe form .

[GNJanbaz in reply to Hidden]

Unfortunately you are suggesting counter diet which will give rise other diseases at this age.No doubt reduce carbohydrates like littlr rice and chappatis with lots of vegetables,cooked and salad

[Avantika]

He is a vegetarian and eats ghee fruits he loves but barely rats them now but thank u shall follow the above

[tanmaymondal1968]

Better to consult another physician. No mention as to whether Janumet is taken once or twice daily.There is another dose I.e 50/1000 of Janumet which may be taken once/twice daily. However, another form of gliptin combined with metformin sr like jitamet plus is newly available in the market with much much lesser cost. In case, everything fails then insulin coupled with other diabetic medicines are the last option with nothing to worry at all as latest kind of insulins can be taken once daily or even once in a week. The side effects of insulin are insignificant apart from gaining weight. You need not to worry at all at this stage as per your statement.

[suramo Star in reply to tanmaymondal1968]

tanmaymondal1968

Sorry bro. Better to avoid insulin. It can cause lethal hypoglycemia. Insulin is the medicine the dose of which one has to calculate oneself every time it has to be taken depending on diet and many other factors.

[tanmaymondal1968 in reply to suramo]

This is a generalised idea about insulin in our country. I know an old lady patient who initially diagnosed with insulin suffered from hypoglycaemia due to problem in fixing the quantity of dose and so being afraid she continued on oral medicines eventually developing critical diabetic problems. So she again visited another reputed doctor who gave insulin to her with some other oral medicines and she is doing very well now at her age about 76. Moreover, interestingly, she is now taking insulin on her own initially under advisement of a professional. No need to panic at all as there are latest types of insulins available in market in India which serve the purpose with least of side effects. I am diabetic for over last 8 years and attend regularly highly qualified endocrinologist with regular check ups for proper control of my sugar level. My mother is also diabetic for more than 25 years and she takes Janumet twice daily with glimepride2mg. Do you know that glimepride has a side effect of hypoglycaemia like insulin. Everybody should fix the dose of diabetic medicines whether insulin or oral only prescribed by a qualified doctor, not by himself/herself as it could be fatal. Don't go by internet advice; rather approach a qualified physician with face to face discussion as he/she will explain in details to you on the side effects of diabetic medicines including insulin in our country and have faith in your doctor completely.

[suramo Star in reply to tanmaymondal1968]

tanmaymondal1968

Everything you said is right but try managing D by diet modification. And see the results. Endos would never advise you about diet. There are many posts here. Go through them. Endos would never advise to get s insulin report done.

[suramo Star in reply to tanmaymondal1968]

tanmaymondal1968

Why i said that every time one has to calculate insulin dosage because insulin more or less the same serum glucose lowering effect as per the dose taken. But you don't take the same amount of carbs and prots. Also our body doesn't have the same response in terms of bs levels every time.

[tanmaymondal1968 in reply to suramo]

Your point is right. But for the very common layperson it is very difficult to set the dosage of insulin on their own everyday depending on the food intake. So, I think before taking insulin, this matter should be discussed very thoroughly between the doctors and patients as well their family members and then the doctor will be able to guide the patient accordingly. As the doctors have the obligation for not allowing the patients suffering from hypoglycaemia, they will do their level best to guide the patients in fixing the dosage of insulin. I know from my personal experience that many patients are surviving on insulin and doing very well under regular check ups and being constantly in touch with their diabetic doctors (which is the key). However, you have made a very good point.

[suramo Star in reply to tanmaymondal1968]

tanmaymondal1968

Well.

1) i don't know any endo who has so much time to spend after one patient.

2) They are not trained for diet.

3) you can't precalculate the amount of carbs taken with each meal.

4) when it comes to treating D hyper is as important as hypos. You have to avoid hypos which can have immediate adverse effects hyper also should be avoided because any bs levels above 140 has detrimental effects.

So best policy is to control D is by diet management and if necessary to go to keto diet for a short time to reduce ir. Insulin should be the last resort only if unavoidable. Believe me going hypocalorie hypocarb diet help you a lot. Personal experience.

[tanmaymondal1968 in reply to suramo]

True to a large extent except the issue on the role of endocrinologists on diet related issues. Nowadays, every reputed endocrinologist refers his/her patients to qualified diatecians as they are able to decide the actual calory intake required for individual patient after takin lots of inputs from the patients depending on their lifestyle etc. the dieticians fix the foods including its types (in a precise manner) to be taken by the patients and it differs from one patient from the other.

[suramo Star in reply to tanmaymondal1968]

tanmaymondal1968

Hope your assumptions about dietitians are true. Well. A little literate people can and should calculate dietary contents themselves. Also people can learn a lot from this forum.

[GNJanbaz in reply to tanmaymondal1968]

A good doctor always suggests taking insulin rather going tomedicines.Insuline dose ca be adjusted by experience and by checking the sugar level through sugar checking instruments which are now affordable

[suramo Star in reply to GNJanbaz]

For type 1.Yes.Inevitable as no medicine except insulin works but for type 2 Illogical and unscientific. T2d are not insulin deficient but have excess of it.Giving external insulin will promote fat formation in our body. Also while on insulin extra carbs esp sugar intake is recommended to prevent hypos.So a vicious cycle sets in.Ultimately IR becomes so high that even very large doses of external insulin can't control sugar which the doctors term as destruction of beta cells. Only idm is scientific, logical and ultimate remedy at present.

[GNJanbaz in reply to tanmaymondal1968]

Using insuline is preferableonly to be cautious about the dose.Best way is at taking insuline check sugar level and adjust dose.You can not always go to doctor,better is be yourself a doctor and read literature concerning diabetes

[tanmaymondal1968 in reply to GNJanbaz]

It is not always possible to go the diabetologist and at the same time it is not at all desirable to become his/his own doctor. During taking insulin at initial stages the patients are guided by a professional (being referred by the diabetologist) and that time the patients have ample opportunity using trial and error options with the help of glucometer to determine the required dosage of insulin in different calories intake scenario. As per my observation, I haven't seen any of reputed diabetologists prescribing for insulin at very initial stage of type 2 diabetic mellitus; rather they prescribe very basic oral medicines. Subsequently, as the body adapts to the diabetic oral medicines, the dosage of such medicines increases in addition to new oral drugs and finally, if the purpose of oral medicines fails, then insulin are suggested as the patients are very scary of taking insulin in our country.

[suramo Star in reply to tanmaymondal1968]

Barring metformin and glitazones all the oral drugs either whip the pancreas to secret insulin which we have more than necessary or prevent absorption of glucose either from git or the kidneys.Illogical and unscientific. Also cause harm to our organs.

[Avantika]

Thank you !

[drrizwan]

take two tbs olive oil extra virgin before sleep and two tbs first thing upon waking up, and time time period between consuming oil and breakfast be minimum 1hour, he'll be amazed to see results and it will greatly reduce his cholesterol triglycerides urea uric acid as well as will be great help in neuropathy .....post his results here after two weeks

[GNJanbaz]

Change to insuline.It is better directly go toinsuline rather than spoil your stomach with steriod containig medicines

[suramo Star in reply to GNJanbaz]

GNJanbaz

D Medicines don't contain steroids. Our aim should be to become drug free or on the least medicines. Forget insulin. T2d can avoid medicines even by diet management alone.

[GNJanbaz]

In thepresent day fast life it is very difficult to hyuave diet which can control sugar level and themedicineswe are beieng prescribed have side effects and doctors advice it is better to start insulin.Now it depends on how you control foodintake

[suramo Star]

Yes.How long depends on how strict one eats low carbs.Within a week. Not only does it improve ppbs but also reverses initial damages. People become insulin prick free and even - if it's early stages renal failure and no esrd - won't need dialysis. But one has to be in keto off and on for the whole life. Some people are on carb free diet for the whole life tolerating keto diet well. Initially there are symptoms of keto flu but gradually our body adapts to the keto diet getting used to ketones instead of glucose as the fuel. And don't worry. Our body produces enough glucose for certain parts of the brain.