The pain in your hands and knees could be due to several reasons, but the mild chest pain is what we need to focus on first. Because you have diabetes, any chest pain should be evaluated by a healthcare professional immediately to ensure your heart is healthy. Please do not start any new medications without a proper medical check-up. I highly recommend contacting your doctor right away so they can safely find the right treatment for you.

Gemer P1 contains glimepiride, metformin, and pioglitazone. The shivering when lunch is delayed is likely hypoglycemia (low blood sugar) caused by the glimepiride component, while pioglitazone can contribute to weight gain. Please do not adjust your dose on your own. I highly recommend consulting your doctor soon to discuss safely adjusting your medication. In the meantime, try to eat meals at regular intervals to prevent shivering, and keep a fast-acting sugar source nearby.

High morning readings (135?150 mg/dL) are actually quite common and often due to natural hormone shifts overnight, known as the dawn phenomenon, or your liver releasing extra glucose while you sleep. I recommend checking your blood sugar around 2:00 AM or 3:00 AM for a few nights to see if it is dropping low overnight. Please share these numbers with your healthcare provider. They can safely adjust your current medication timing, such as metformin, or suggest a light bedtime snack to help keep your morning levels in a healthier range.

Taking Zita Med Plus alone is not the same as taking Zita Plus and Gemer 2 together. Zita Plus contains teneligliptin, and Gemer 2 contains glimepiride and metformin. Zita Med Plus only combines teneligliptin and metformin; it does not contain glimepiride. Removing Gemer 2 would mean she misses the glimepiride, which could cause her blood sugar levels to rise. For her safety, please do not alter her dosage or switch these medications without consulting her prescribing doctor.

Type 2 diabetes is managed with Gemer and Voglibose. A blood sugar level of 176 mg/dL at random is slightly elevated, but it might be acceptable based on when you ate and your doctor's recommended ranges. Keep taking your medications as directed, stay away from sweets and sugar-filled beverages, eat a balanced diet, get regular exercise, and keep an eye on your blood sugar levels. To determine if your diabetes is generally well controlled, routine HbA1c testing and doctor follow-up are crucial.

Your current routine using Gemer (glimepiride/metformin) for diabetes and Cildipine (cilnidipine) for high blood pressure is a very standard and effective approach. Your homocysteine level of 26 is elevated, and taking your prescribed vitamin supplement twice daily is the appropriate way to help bring this down. To ensure these specific doses are still perfect for you, please have your doctor review your latest blood sugar and blood pressure readings.