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Diabetic for 10-15 Years, Can't Lower Hemoglobin: What Can I Do?

Dr Chandrakant Lahariya | Answer |Ask -Follow

Diabetologist, Consultant Physician, Vaccine Expert - Answered on Oct 17, 2024

Dr Chandrakant Lahariya is a diabetologist, an infectious diseases and public health specialist and a vaccine expert.
The Delhi-based senior physician also has over 20 years of experience in hypertension, thyroid disorders and respiratory illnesses.
An expert on common health issues and the preventive aspects of medicine, he has co-authored the book, Till We Win: India's Fight Against The Covid-19 Pandemic.
Dr Chandrakant completed his MBBS from the Maulana Azad Medical College, New Delhi, and his MD from the Lady Hardinge Medical College, New Delhi.
He has a DNB (National Board of Examination, 2009) certification and a diploma in vaccinology from Institut Pasteur, Paris.... more

Question by Sunil on Oct 16, 2024Hindi

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Hi, I have diabetics from last 10 15 years. I live in USA. I tried every thing. I am vegetarian walk 7 to 8 mile regular walk. Eat Salad fruits and only two roti and dal every day . Taking medicine like Jardiance 10 mg , some insulin one time and control on food like namkin , sweets etc but Hemoglobin does not come down . It is 7.5 to 8.5 most of time. I don't understands why it is not coming down. Do you have any suggestion. Please advice.

Ans: Please let me know your age.
HbA1c 7.5 to 8.5% is not very bad. You can increase Jardiance to 25 mg. However, you are not taking Metformin which is a very good sensitizer and anti diabetic medicine, which need to be added to your treatment. If that is done, I beleive your blood sugar level will come within normal range.
Thereafter, continuing with healthy lifestyle as you have mentioned and some more uptitrating with insulin, your blood sugar levels may be within normal range.

Since your diabetes is for last 15 years, please get routine eye, kidney and metabolic health check up.

Dr Chandrakant Lahariya
Centre for Health: the Specialty Practice,
New Delhi, India

Asked on - Oct 22, 2024 | Answered on Oct 24, 2024

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Thank you for reply. I am almost 65 years old couple months shorts. I took metformin in past but nothing happened. No changes at all. I read so much bad things about Metformin. I am loosing weight since i started taking Jordiance 10mg. I am 150 to 152 lb from 175 lb. I am very skinny. I am looking skinny day by day. There is no meat in my body just bones. I am not sure increasing Jordiance 10 mg to 25 mg will help. I am just afraid that will loose more weight. Is there any other medicine or some thing else which can help improve my A1C and Diabetics. I am in good health. Kidney and eye is in good condition. I am regular in my health check. we are required to checkup twice in a year by Insurance company in USA. Please suggest what else i can do to improve

Ans: Thanks.
Now, you have to please tell me your height also. The idea weight is height in cm minus 100. So, if you are not very short of ideal weight, please do not worry.
Metformin is one of the most commonly used anti-diabetic medication. It does reduce weight but very marginally. Similarly, Jardiance/Empa cause some weight loss but not what you have indicated.
Not sure if you are using statins. if yes, that could be possible reason as statins are known to cause muscle loss, which is a worrying concern after 60s.
Your weight reduction could also be linked to your healthy and active lifestyle.
Please let me know your BMI or even better, body fat percentage. At your age, mere weight is not a good criteria. Better approach is to have muscle, which can be strengthened by muscle strengthening or resistance exercises. So, as you are doing a lot of physical activity / cardio but resistance and strengthening exercises could be added.

You might also benefit from a little more intake of proteins in diet (as you have not indicated any kidney issue.

regarding your looking skinny day by day, let me comment once you provide additional information.

Thanks and best wishes,
Dr Chandrakant Lahariya
Centre for Health: The Specialty Practice
Safdarjung Enclave, New Delhi, India

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