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From New Castle, Pennsylvania, USA:

I am a 57 year old woman diagnosed with type 2 diabetes 15 years ago which initially controlled with diet and exercise, and I am now taking a sulfonylurea and Glucophage [metformin] daily. My two hour postprandial results are often 300 mg/dl [16.7 mmol/L] so my doctor has prescribed Humalog before meals instead of Actos because she is concerned about the side effects of Actos. I am not opposed to beginning an insulin regimen and just want what is best for my long-term health. Any help you can provide would be appreciated.


It sounds like the insulin will be a better treatment for the high postprandial blood sugars. If your hemoglobin A1c is more than 2% above your target, I do not think the Actos [pioglitazone] will be all you need.

It does sound like insulin therapy would be best. You probably need to go ahead and invest in this therapy as the best way to treat your elevated blood sugars. Over 40% of patients end up taking insulin for their primary treatment of their diabetes. This is the natural history of the disease.


[Editor's comment: There really are quite a few choices that a physician might advise in your circumstances:

  1. Go back to your dietitian, and see if you can "tighten up" your meal plan (probably worthwhile with any of the following!)
  2. Add one of the "glitazones" (pio or rosiglitazone)
  3. Switch to insulin, discontinuing all the pills
  4. Add a basal insulin to the present pills (Bedtime NPH or Ultralente or Lantus (insulin glargine))
  5. Add pre-meal short-acting insulin to the present pills (as your doctor advised).
None of these options is "right" or "wrong", and if one doesn't work out, it's perfectly okay to switch to another. As Dr. Lane mentions, type 2 diabetes is a progressive disease, and changes in therapy are usually needed as the years go by. WWQ]

Original posting 15 Dec 2001
Posted to Type 2


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