by Renu Kapoor
(India)
QUESTION: For the last two months, I have been taking Lantus at night, Galvus 50 and Amaryl MP2 Forte before breakfast, and Amaryl M-1 Forte before dinner. My before-dinner glucose is usually around 120–160 mg/dL, but my morning readings are often 59, 66, 64, or 72 mg/dL. My HbA1c is 8.6%. Should I seek another medical opinion?
Morning readings of 59–66 mg/dL are hypoglycemia and should not be ignored. Contact your prescribing endocrinologist or diabetes clinic promptly—preferably today—to review the nighttime insulin and all combination tablets. Do not add another medicine or change any dose on your own. An HbA1c of 8.6% is above the usual goal for many adults, but lowering it must be done without causing repeated low blood sugar.
Answer by Dr. Albana Greca, MD, MMedSc
Hi Renu,
Your glucose pattern needs a prompt medication review. Lantus is long-acting basal insulin. Amaryl products contain glimepiride, a sulfonylurea that can also cause hypoglycemia. Using insulin together with a sulfonylurea can increase the risk of low glucose, especially overnight or when meals are delayed. Because fixed-dose products may contain additional medicines, take the original boxes or clear photographs of every label to your appointment.
If you are awake and able to swallow, take about 15 grams of fast-acting carbohydrate, such as glucose tablets or glucose gel. Recheck after 15 minutes and repeat the treatment if the reading remains below 70 mg/dL. Once it is above 70 and improving, eat your planned meal or snack if the next meal is not soon.
Do not use chocolate or high-fat sweets as the first treatment because they may raise glucose too slowly. Do not exercise, drive, or go back to sleep while your glucose remains low.
Call emergency services if you become confused, have a seizure, faint, cannot swallow safely, or need another person’s help. Someone who is unconscious should not be given food or drink by mouth. Family members should know how to use prescribed glucagon and when to call for emergency help.
HbA1c reflects your average glucose over roughly the previous two to three months. It can remain high when glucose rises after meals or during other parts of the day, even if it becomes too low overnight. This pattern may mean that the current treatment is lowering overnight glucose too strongly while not fully controlling daytime or after-meal elevations.
The answer is not automatically to add a lunchtime tablet. Your clinician should first review your exact medicines, doses, meal timing, kidney and liver function, recent weight changes, injection technique, and glucose pattern.
For several days, record your glucose before breakfast, before dinner, at bedtime, and whenever symptoms occur. Your clinician may also request readings one to two hours after meals or recommend a continuous glucose monitor. Note the time and dose of each medicine, meal timing, exercise, and any symptoms. A structured blood sugar log can make the pattern easier to review.
A second endocrinology opinion is reasonable if you cannot obtain a prompt review, the medication instructions are unclear, or low readings continue despite discussing them with your current doctor. However, you do not necessarily need to change doctors if your current endocrinologist can review the regimen quickly and provide a clear prevention plan.
Do not skip or delay meals while taking medicines that can cause hypoglycemia. Choose regular, balanced meals with appropriate portions of carbohydrate, protein, vegetables, and healthy fats rather than following an extreme low-carbohydrate plan without medical supervision.
Physical activity is beneficial, but running with glucose below 70 mg/dL is unsafe. Discuss exercise timing, glucose checks, and carbohydrate needs with your diabetes team. Cinnamon, bitter melon, gymnema, and other supplements should not be used to replace treatment or reduce prescribed medicine doses; they may have unpredictable effects and interactions.
The immediate priority is preventing recurrent morning hypoglycemia. Ask your doctor to review whether your basal insulin or any glimepiride-containing combination needs adjustment, but do not make that adjustment yourself. Also ask for a written low-glucose plan, a glucagon prescription, and individualized fasting, after-meal, and HbA1c targets.
Educational safety note: This answer is for general diabetes education only. It does not replace personal medical advice, diagnosis, or treatment. Do not start, stop, or change medicines, supplements, diet, or exercise plans without speaking with your healthcare provider.
Last reviewed: July 2026.
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