My 47 year old father has had diabetes for eight years. His fasting glucose level fluctuates between 11.6 to 13.5 mmol/L [209 to 243 mg/dl]. His random sugar level is around 15 mmol/L [270 mg/dl]. He is on metformin (500 mg) and glibenclamide. He eats rice two times in a day. He has slight elevation in his LDL cholesterol level (6.3). He exercises regularly, does not consume alcohol or smoke, and has not yet experienced any major complication of diabetes.

He was told to take one and a half glibenclamide twice a day. He did not really follow this advice because the medicine causes gastrointestinal discomfort. He kept the medicine in the freezing compartment of the fridge. Will all this affect the drug’s effectiveness? When is the best time to consume this drug (before, during, or after meal)?

Is it true that cinnamon and bitter melon help to reduce glucose level?

Can diabetic nephropathy be reversed?

If both drugs are not successful in lowering is glucose level, what should be done?

I will answer your questions in the order you have presented them.

We do not routinely tell our patients to keep their medication in the freezer. I am concerned that freezing the medication may decrease its efficacy somewhat. However, it would not likely render it completely ineffective. We tell our patients to take their medications with their meal, especially the metformin, as it can cause some gastrointestinal symptoms. I would talk the glibenclamide with the metformin to make it easier to remember.

Cinnamon has been studied as an agent to treat diabetes. It has only weak properties to lower glucose levels. In the U.S., people mix cinnamon with sugar and I doubt this is very effective at treating diabetes. However, in other countries, cinnamon is used by itself. It clearly will not hurt. Bitter melon and its effect on diabetes is less familiar to me.

Diabetic nephropathy, or the effect of diabetes on the kidney, has been shown to be reversed in patients who have received pancreas transplants over at least 10 years. This means a rather potent treatment instituted for a fairly long time may be able to reverse established kidney lesions. A more realistic approach is to work on prevention. The use of good glucose control has been shown to prevent nephropathy. In addition, there are certain medications that have been approved for blood pressure control that can help to stabilize nephropathy once it is clinically recognized.

If both drugs, used at their maximum doses, do not control blood sugars, your father should check with his doctor about another drug choice. Depending on how close he comes to target blood sugars, this may be another pill or it may be insulin. The insulin would be used if he is still far from his target blood sugar.

JTL