Sugar fluctuations. Of taking insulin!

current blood sugar profile suggests that her diabetes is not well controlled, even after reducing her dose to Glimisave 1.3. Her blood sugars are consistently high (Fasting 143, PP > 200), and yet she experiences hypoglycemic symptoms (like giddiness, hunger) when her sugar nears 140. This could indicate that her body has gotten used to high sugar levels over time — so even relatively lower (but normal) values feel like hypoglycemia to her. you should remember 1. Persistent Post-Meal Hyperglycemia: Post-lunch and post-dinner sugars are quite high (245–268), indicating that her current dose of Glimisave 1.3 may be too mild to control the postprandial spikes. 2. Hypoglycemic-like Symptoms at Normal Sugar Levels: These symptoms are likely "pseudo-hypoglycemia" — when blood sugar falls rapidly (even to normal range like 130–140), it causes hypoglycemia-like symptoms because the body is used to higher sugar levels. This usually improves over time with better control. 3. Visual Impairment and Insulin Concern: It's true that impaired vision due to glaucoma can make insulin administration difficult, especially if she can't measure or inject properly herself. However, modern insulin pens with pre-set doses or caregiver assistance can solve this problem. Insulin is the safest and most effective option for many elderly diabetics with poor control. 4. Medicine Safety: Glimisave contains Glimepiride + Metformin, which is usually safe in low doses but can still cause hypoglycemia, especially in the elderly or with poor appetite.

Diet Review: She may need a tailored diabetic diet with consistent carbohydrate intake across meals to avoid sugar spikes and drops. Blood Sugar Monitoring: Continue SMBG (self-monitoring) and note trends. If possible, consider using a CGM (Continuous Glucose Monitor) for a week to assess the fluctuations. Medication Adjustment: If Glimisave 1.3 is still causing issues, she might benefit from switching to DPP-4 inhibitors (like Sitagliptin or Vildagliptin), which are safer in elderly patients and don’t cause hypoglycemia. Insulin (basal-only or premixed low dose) with proper support can still be a better long-term choice if oral medicines fail. Addressing Pseudo-Hypoglycemia: This will improve as average sugars gradually reduce. Small, frequent meals and adjusting the target sugar levels gradually can help.

Please consult her diabetologist soon to discuss these sugar values and treatment options. Insulin isn't unsafe if properly handled, and safer oral options exist. Don’t ignore the risk of complications due to prolonged high sugar levels.

She needs to be evaluated fully and need detail history to be taken before commenting on anything please consult for more

The meds are ok . These meds also causes hypoglycaemia symptoms. U have to be careful of dose timings . Like u have to take it either before food or with first bite . Next is keep a check on symptoms. Dont take large and heavy meals at one time . This may cause reactive hypoglycaemia because of sudden dip in sugars .

Check vit -b12 levels as these meds causes deficiency and co existing symptoms of lethargy and nerve weakness

Take tab neurobion forte along with this tablet ..

It is better to have Cgm with sensor. We can monitor contiuously and can titrate the treatment.

Try for pen insulin n changes in OHA needed , please consult