I am 67 years old having diabetics since last 10 yrs. From last one years it is not controlled FBS and PPBS s to more than 250 Glinison 2 daily two tablets one at the time of breakfast and another at the time of dinner moreover insulin human mixtard 20u before lunch and 14u before dinner recently Daonil started 1-1-1- please advise me.

Dr. Prabhakar Laxman JatharEndocrinologist46yrs exp

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Mr. Lybrate-user, it appears the dosage of insulin is not adequate, needs to be uptitrated. This can be done by first targeting fasting sugar level and later pp sugar level. Night time insulin dose can be increased by 2 to 4 units every 3 rd day based on fasting glucose level till target level is achieved, through a system of self monitoring and getting info from your doctor on insulin dose, till a trget level (120 mg fasting) is reached. I do not understand the reason for starting dionil now, because it is not suitable in old age as it can precipitate severe hypoglycemia. Dionil or glimepiride push pancreas beta cells to produce insulin, but if there is no reserve of beta cells then these drugs have no action at all. 

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