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This is The prescription of my grandmothers of Diabetes, her sugar level is 400 which is very high she has now complaints of severe burning sensation of Soul , analyse the prescription and help me to what to do
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Prescription Analysis for Jeevanabee Mahammadsab Umachagi
Doctor: Dr. V. S. Hosmath, MD, FCCP (Consulting Physician)
Date: 13/05/2026 | Weight: 55.1 kg | BP: 140/80 mmHg | OPD No: 4153
Complete Medication List (All 11 Items)
| # | Medicine | What it is | How to Take | Duration |
|---|---|---|---|---|
| 1 | TAB Hytel-40 (Telmisartan 40mg) | Blood pressure tablet (ARB) | 1 in morning, 0 afternoon, 0 night | 1 Month |
| 2 | CAP Inkrizz (Methylcobalamin + Nerve vitamins) | Vitamin B12 nerve supplement | 0 morning, 1 afternoon, 0 night | 1 Month |
| 3 | TAB Ad-Sita-D 10/100 (Dapagliflozin + Sitagliptin) | Diabetes medicine (two drugs combined) | 1 morning, 0 afternoon, 1 night | 1 Month |
| 4 | GEL Grantin-D (For Skin Application) | Antifungal + steroid skin gel | Apply morning and night | 15 Days |
| 5 | CAP Metabol-4G | Omega-3 / metabolic supplement | 0 morning, 1 afternoon, 0 night | 1 Month |
| 6 | CAP Itrafung-200 (Itraconazole 200mg) | Antifungal capsule (for fungal infection) | 1 morning, 0 afternoon, 0 night | 15 Days |
| 7 | OINT H H Derm | Antifungal/skin ointment | Apply morning and night | 15 Days |
| 8 | INJ Nobeglar (Insulin Glargine - Basal Insulin) | Long-acting insulin injection | 10 Units at night only (inject under skin) | 1 Month |
| 9 | TAB Preganor-NT (Pregabalin + Nortriptyline) | Nerve pain tablet | 0 morning, 0 afternoon, 1 at night | 1 Month |
| 10 | TAB Eticox-60 (Etoricoxib 60mg) | Pain/anti-inflammatory tablet | 1 morning, 0 afternoon, 0 night | 15 Days |
| 11 | OTH B C Ferrol Sachet (Vitamin D3 / Cholecalciferol) | Vitamin D supplement | 1 sachet, once a week | 1 Month (4 sachets) |
About the Burning Sensation in the Sole (Very Important)
Your grandmother's burning sensation in the sole/feet is almost certainly Diabetic Peripheral Neuropathy - a very common complication when blood sugar stays high for a long time. With sugar at 400 mg/dL, nerve damage is expected.
Good news: The doctor has already prescribed medicines for this:
- Inkrizz (Methylcobalamin) - B12 nerve repair vitamin - helps regenerate nerve cells
- Preganor-NT (Pregabalin + Nortriptyline) - This is the main medicine for the burning/nerve pain. Pregabalin is approved specifically for diabetic peripheral neuropathy and is a first-line treatment per Harrison's Principles of Internal Medicine. Take it at night as prescribed.
- Metabolol-4G - Omega-3/metabolic supplement also helps nerve health
The burning will reduce only when:
- Blood sugar comes under control (target: fasting below 130, post-meal below 180)
- Nerve medicines take effect (may take 2-4 weeks)
About the High Blood Sugar (400 mg/dL) - What to Do
The doctor has started insulin (Nobeglar 10 units at night) which is appropriate. However, sugar of 400 is dangerously high and here is what you should do:
Immediate Actions:
- Give the insulin injection at night without fail - 10 units of Nobeglar (insulin glargine) injected under the skin of the abdomen or thigh. If you have not started insulin yet, start tonight.
- Strict diet - No rice, white bread, sugar, sweets, fruits like mango/banana/grapes, fruit juices. Eat small portions of whole grains, vegetables, dal, roti.
- Check blood sugar daily if you have a glucometer - aim to monitor and track.
- Keep her well hydrated - give water regularly as high sugar causes dehydration.
Warning Signs - Go to Emergency Immediately if:
- Vomiting, extreme weakness, or confusion
- Sugar goes above 500 mg/dL
- Fruity/sweet smell on breath (sign of ketoacidosis)
- She cannot eat or drink
About the Skin/Fungal Medicines
Diabetics with high sugar are very prone to fungal infections. The doctor has prescribed:
- Itrafung 200 (oral antifungal) - 15 days
- Grantin-D Gel and H H Derm Ointment - for skin application morning and night
These suggest she may have a fungal skin infection, which is common with uncontrolled diabetes.
Summary of What to Do Right Now
- Start ALL 11 medicines exactly as prescribed - do not skip any
- Insulin at night is mandatory - 10 units Nobeglar under the skin
- Preganor-NT at night will help the burning sensation in 1-2 weeks
- Strict diet control is non-negotiable with sugar at 400
- Follow up with Dr. Hosmath in 2-4 weeks or earlier if sugar doesn't come below 250
- Apply skin gel and ointment morning and night as prescribed
- BC Ferrol sachet: only once a week - not daily
Important Disclaimer: This is an educational analysis only. Please follow Dr. V. S. Hosmath's instructions as given. If your grandmother's sugar stays above 400 after starting medicines, or if she develops any emergency symptoms, visit the hospital immediately or call Dr. Hosmath at (08372) 275442.
And she has habit of drinking tea frequently
This is a very important point for a diabetic patient with sugar at 400 mg/dL. Here is a clear breakdown:
Tea Habit and Diabetes - What You Need to Know
Why Tea is a Problem for Her Right Now
The issue is not the tea itself - plain tea (without sugar and milk) is actually fine. The problem is how most people in India drink tea:
- Sugar in tea - Even 1 teaspoon of sugar = ~4g of simple sugar that spikes blood glucose very fast
- Milk in tea - Full-fat milk adds carbohydrates (lactose) and calories
- Frequent cups (4-6 times a day) - This adds up to a significant sugar load throughout the day, constantly keeping blood sugar elevated
With her sugar already at 400 mg/dL, every cup of sweet milky tea is actively making it worse and counteracting the medicines the doctor has prescribed.
Practical Guidelines for Her Tea Habit
| Situation | What to Do |
|---|---|
| She insists on tea | Allow it, but strictly no sugar |
| Sweetness needed | Use stevia (natural) or Sugarfree Natura/Zero sweetener - these do NOT raise blood sugar |
| Milk | Use small amount only - 1-2 tablespoons of low-fat milk, not full-fat |
| How many cups | Maximum 2-3 cups per day - not 6-8 cups |
| Timing | Not on empty stomach - have something light before tea |
| Avoid completely | Tea with biscuits, rusk, or Marie biscuits - this is a very common habit that silently raises sugar significantly |
Additional Tea-Related Concerns for Her Specifically
-
Telmisartan (Hytel-40) she is taking is for blood pressure (140/80). Too much tea - especially strong tea - contains caffeine which can temporarily raise blood pressure. This works against her BP medicine.
-
Pregabalin (Preganor-NT) causes drowsiness. Caffeine in tea may partially counteract this, but it is not a reason to drink more tea.
-
Dehydration - High blood sugar already causes the body to lose water through urine. If she replaces plain water intake with tea, it can worsen dehydration. Encourage 8-10 glasses of plain water daily alongside.
What She Can Drink Freely
- Plain water - best choice, as much as possible
- Unsweetened black tea or green tea - actually beneficial, has antioxidants
- Buttermilk (chaas) without salt - good for diabetics
- Vegetable soups (no potato, no corn)
- Fenugreek (methi) water in the morning - naturally helps lower blood sugar
Bottom Line
Tell your grandmother: "Chai peena band nahin karna, bas cheeni bilkul mat daalo." She can have her 2 cups of tea - but with a sugar-free sweetener and very little milk. This one change alone can make a noticeable difference in her sugar levels within weeks.
The goal right now is to bring her sugar from 400 down to below 200 as quickly as possible so the nerve burning in her soles also begins to reduce.
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