AboutDomenic Sica Expertise All aspects of hypertension as well as any consideration in drug therapy for the management
of hypertension.
Experience Heavily published in the area of drug therapy in hypertension and renal disease. Primary management physician for a large multi-state referral practice for diagnosis and management of complex hypertension
Organizations Multiple including the American Society of Hypertension, International Society of Hypertension, American Society of Nephrology, American Heart Association, American College of Clinical Pharmacology amongst others.
Publications Over 250 publications (see PubMed)
Education/Credentials Board certified in internal medicine, nephrology, clinical pharmacology, and hypertension
Awards and Honors Multiple awards as clinical and/or teacher of the year.
Question QUESTION: I am male 53 years from India and suffering from hypertension since 1990 and currently on Norvasc Toprol XL 100 and Cozaar 100
In 2007, I had my blood profile wherein my HbA1c was 7.7 In 2008 it was 7.1 and currently it is 8.20. My fasting sugar levels remain around 110 112 114 121. I have undergone OGTT thrice during 3 years latest being last month where the value was Fasting 112 after one hour it was 180 and after 2 hours it was 152. I was doing walking. Mu thyroid profile lipid profile ( HDL 34 LDL 67 Triglyceride 97 S Cholestrol 109 VLDL 24 Creatinine 0.90 ) all are within normal limits.
Despite elevated HbA 1C and impaired fasting glucose I am still not on medication But I read from your responses that medications over and above life style medications are vital in the control of pre diabetic stage. I am deeply worried rather very much scared to have a new disease. Can U guide me what should I do. Today, I had my post prandial which was 181 which is alarming.
I am staying away from family and worried Can you guide me what should I do to improve my glucose level. I shall be greatly obliged by your guidance.
ANSWER: The simplest step would be to have your physician take you off of the beta-blocker Toprol and to have the discussion with him/her as to your concern about these values. A suitable substitute would be doxazosin, a blood pressure medication without negative effects on glucose. The next step if you were in the United States would likely be the addition of the drug metformin, which is used for its direct effects on glucose abnormalities.
Regards,
Domenic Sica, M.D.
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QUESTION: I am in India My dr suggested me to take metformin 500 mg as I have a HbA1c ranging from 7 to 8 during a span of 6 months and IGT IFT for more than 3 occassions.My further queries are :
1. Does metformin delays the progression of the diabetes
2. Doses brisk walking lowers blood sugar and improve HbA1c
3 I have paplitation Tachycardia and Toprol has been suggested for this missing beats PVCs
4. My dr also suggested to take Ramipril 2.5 mg in addition to what I am taking. I am on Losartan 100 Indapamide 1.5 Amlodepine 10 mg Metoprolol 100. In addition, he suggested Ramipril for kidney protestion because of higher than normal Blodd sugar Can U guide me I shall be obliged to receive your further guidance
Answer Metformin does delay the progression of diabetes. Brisk walking, particularly if it leads to weight loss, improves HbA1C. As to the Toprol maybe a lower dose will still suppress the missed beats. There is no evidence that adding ramipril will do anything relative to kidney protection above and beyond the losartan that is already being used. How you address this with your physician would have to be done delicately and respectfully in that I cannot be recommending how you should be treated but rather should simply be answering your questions.
