Brief Answer:
Hello

Detailed Answer:
Hello
Good day.
Thank you for writing back to me.
Noted your points. I feel that, if we are able to bring down your Fasting glucoe readings to less than 110, the postmeal readings also will fall proportionately.

You do not have to break the Januvia 100 mg to two times. you can take 100 mg tablet once daily. Slowly, we can increase your dose of metformin to 850 mg twice daily after around 10-12 days. Beleive me, it is not a big dose. I noted that your weight was 92 kg. You need a good dose of Metformin.

Please start doing a 30-40 minute brisk walk or smilar kind of exercise. I am sure that this will surely bring down the blood glucose readings to normal. If it dosnt, then we need to do some modifications.

Regards
Binu

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Brief Answer:
Hi

Detailed Answer:
Hello,

It is my pleasure to answer your questions,

Shall discuss one by one.

1- Do you mean I have to take Januvia + metformin 850 mg twice daily ?? if yes with this dose I will lose too much which Weight because usually I am losing weight very easily .

Yes. At your weight, that is a good dose. You may lose 2-3 kilos which will beefit you for diabetoc control. But if you are afraid of weight loss, you may use JanuMet (50/500). This is a combination of 50 mg Januvia and 500 mg Metformin.

2 - do you mean by metformin Glucophage XR is it the same.

Yes. same.

3- yesterday and today around 11 pm , my blood sugar level dropped drooped to 90 mg. and that is very strange for me and never happens with me before is it good or bad sign ???

That is not a low level. it is a very uch normal level. This is infact a good sign

4 - I come to know that (Januvia) is type of medicine which Stimulates the production of insulin and that make Exhaustion of the pancreas and will lead to non working of pancreas in the future . is it right ???

Januvia stimulates the insulin productiopn ina different way compared to older medicines like Diamicron. It doest cause beta cell exhaustion and on the contrary has been shown to impove beta cel survival.

5- Shall I do any laboratory test to check the other factors like Hormones and glands maybe it would the reason for the sudden changes or that is development of the diabetic ??? and is there any test to check the efficiency of the pancreas ???

i do not think you need any special tests apart from the diabetes and end organ check up ( feet, eyes, kidneys, urine, chlesterol, liver function) etc.
You may need to do a C-petide test to look for pancretic efficiency

Regards
Biu

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