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Experts at Chellaram Diabetes Clinic, Pune answer your queries on Diabetes. Send your questions to editorial@Diabeteshealth.co.in

I'm a mother of an 8 year old girl with Type 1 Diabetes. She has been prescribed to take insulin twice a day. I would just like to know what the normal medication regime is for patients like her.

In Type 1 Diabetes mellitus, there is absolute deficiency of insulin in body hence for such patients the treatment plan involves subcutaneous administration of insulin.

The normal physiology of the pancreas is to produce insulin in two phases:

• Basal insulin production
• Meal-related (also called prandial) insulin production

Basal insulin is secreted by the pancreas for 24 hours continuously, whereas prandial insulin is secreted in response to nutrients to cover the sudden rise in blood glucose levels after meals. Hence the best regime for Type 1 Diabetes is basal-prandial (also called basal-bolus) insulin regime. Basal insulin includes long acting insulin like glargine or intermediate acting insulin like neutral protamine Hagedorn (NPH) at bedtime. Bolus insulin will be short acting regular insulin or short acting insulin analogue which has to be injected before each meal. The advantage of an insulin analogue over regular insulin is that it can be injected just before a meal or even just after a meal. Also the dose of such insulins can be adjusted depending on the quantity of the meal. As a parent you need to watch out for symptoms of hypoglycaemia (low sugar feeling) as most kids do not finish their meal. In your case as your daughter is taking insulin twice daily, it is likely to be pre-mixed insulin. However a basal bolus regime would be more appropriate for your daughter. In any case it is best advised that you consult your doctor to help take the final decision.

Manish Bothale

Consultant Physician

My wife is 62 years old and was recently diagnosed with Type 2 Diabetes. She has been prescribed metformin (1/2 tablet morning and evening) along with aspirin 75mg. She also has a single kidney and recently her kidney functions test revealed that all her parameters were normal. Considering her present status is metformin and aspirin safe for her or would you recommend repaglinide and aspirin or clopidogrel? Please advise.

As her kidney function tests are within normal limits, Metformin is a safe anti-diabetic medicine for her. Aspirin is safe too. There seems to be no need to switch to any other medicine right now, if the blood glucose is well controlled. Normally doctors prescribe Metformin with caution if serum levels of creatinine (a high creatinine indicates that the kidney isn't working well) is higher than upper limit of normal (that is >1.5 mg/dl) as there is a risk of lactic acidosis. I would suggest that you monitor the kidney function test and repeat the test every six months. Also it is necessary the she should maintain her blood glucose level, blood pressure and lipid profile to prevent diabetic kidney disease.

Vedavati Purandare

Consultant Physician