Brief Answer: Dietary restriction, weight reduction and exercise Detailed Answer: Hi XXXXXXX Thanks for your query. Apart from most of the anti-depressants, diabetes and under-active thyroid also cause weight increase. Hence, Thyroid Profile should be done to rule out/detect underlying undiagnosed hypothyroidism. Incidentally, mood disorders is also a feature of hypothyroidism. Further, I agree that your sugar levels are grossly elevated. You will therefore need much more medicines than the present drug/dose. Addition of an effective anti-diabetic drug, such as Glimepiride, apart from increasing the dose of metformin would certainly control the sugar levels to within the desirable range. Also, in the presence of obesity, there is a possibility of insulin resistance (a component of Metabolic Syndrome). Therefore, blood insulin levels should also be evaluated. Please bear in mind that ideal control of blood sugar is a slow process, as it is done by trial and error method. The dose requires titration, depending on the blood sugar levels. Once the sugar level is under fair control, the regime is finally modified to maintain 24-hours' control. Dietary restriction, lifestyle modification, regular physical exercises and, above all, weight reduction to a BMI of 25 would go a long way in controlling your sugar levels. Consult your doctor and apprise him of my opinion. I am certain that he will agree with me and will prescribe the advised drugs in appropriate doses. Hope I have addressed your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Take care Dr. Rakesh Karanwal

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