QUESTION:
By Raj
I have had type 2 diabetes for 18 years. Until recently, my fasting glucose was about 95–110 mg/dL and my HbA1c was 6%–6.5%. Now my fasting glucose is around 145 mg/dL and my HbA1c is 7.5%. My doctor changed my medicines. I now take a sitagliptin–metformin combination twice daily and gliclazide 30 mg—two tablets before breakfast and one before dinner. I also have a brown oval spot near my left shin and sometimes feel heat or burning in the sole of my left foot. What do these findings mean, how do the medicines work, and how do they compare with Diamaxol?
Quick Answer
A fasting glucose of 145 mg/dL and HbA1c of 7.5% are mildly above the common goals used for many adults, but the correct target must be individualized. Sitagliptin–metformin and gliclazide can be used together, although gliclazide increases hypoglycemia risk. Confirm the exact strengths and whether the gliclazide is immediate-release or modified-release because dosing instructions differ. The shin spot may be diabetic dermopathy, but a single lesion should be examined. Burning in one sole may reflect neuropathy or a local nerve, skin, spine or circulation problem. Diamaxol is a dietary supplement, not a proven substitute for prescribed treatment.
Answer by Dr. Albana Greca, MD, MMedSc
Hello Raj,
After 18 years, type 2 diabetes may progress as insulin production declines. Weight, food, activity, illness, stress, sleep, steroids or missed doses can also raise glucose.
They are not usually an emergency but need follow-up. Common targets for many adults are fasting or premeal glucose 80–130 mg/dL and HbA1c below 7%, individualized for health and hypoglycemia risk.
Interpret HbA1c with fasting and selected two-hour after-meal readings. See our HbA1c guide.
Sitagliptin is a DPP-4 inhibitor that prolongs incretin hormones, supporting glucose-dependent insulin release and reducing glucagon.
Metformin reduces liver glucose production and improves insulin sensitivity. Both medicines have low hypoglycemia risk when used without gliclazide or insulin.
“50 mg sitagliptin–metformin” is incomplete because the tablet also has a metformin strength. Confirm the full strength and whether it is immediate- or extended-release.
Gliclazide is a sulfonylurea that stimulates insulin release and can cause hypoglycemia, especially with delayed meals, more exercise or reduced kidney function.
Your reported total is 90 mg daily. A 30-mg tablet is often modified-release and commonly taken once daily with breakfast, while other formulations differ. Confirm the formulation and evening dose before changing anything.
Watch for low glucose: Shaking, sweating, hunger, dizziness, confusion, weakness or waking at night with symptoms can indicate hypoglycemia. Check glucose during symptoms and carry fast-acting carbohydrate. See causes and treatment of low blood glucose.
Kidney function affects all three medicines: metformin safety, sitagliptin dosing and gliclazide hypoglycemia risk depend on eGFR.
Ask about eGFR, urine albumin and vitamin B12. Long-term metformin can lower B12 and mimic neuropathy symptoms.
Diabetic dermopathy usually causes painless, flat, round or oval brown shin spots that do not itch, drain or ulcerate.
A single spot could instead be trauma, eczema, infection, venous discoloration or another lesion. Seek examination if it changes, becomes raised, painful, warm, ulcerated or bleeds.
Dermopathy may not disappear when glucose improves. Review our diabetes skin-care guidance.
Diabetic neuropathy often starts in both feet. One-sided burning may still be neuropathic, but local causes should be considered:
He needs foot inspection, pulse assessment, 10-g monofilament and vibration testing. See our neuropathy guide.
Seek prompt care for an open wound, spreading redness, swelling, pus, fever, a cold or discolored foot, sudden numbness or weakness, severe pain, or a blister that is not healing.
Diamaxol is a dietary supplement, not an approved diabetes medicine, and lacks the predictable dosing and outcome evidence required of prescription treatment.
It is incorrect to call it harmless. Supplements may interact with gliclazide and increase low-glucose risk. The FDA previously described Diamaxol as misbranded in a warning letter.
Do not add Diamaxol or replace medicine without showing its exact label to a clinician or pharmacist.
This answer does not replace examination or medication advice.
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