From Jakarta, Indonesia:
I have mild diabetes. My A1cs are usually under 6.0, but my fasting blood glucoses have been in the 120 mg/dl [6.7 mmol/L] to 134 mg/dl [7.4 mmol/L] range for five years. I have been using diet and exercise alone to control my diabetes. Is it safe for me to use Lantus or another long-acting insulin to control the basal blood sugars? Why are my fasting blood glucoses this elevated? My 90 to 120 minute post meal numbers are mostly under 140 mg/dl [7.8 mmol/L]. What effects are there if someone with type 2 uses early insulin therapy without any pills like metformin and TZD, because they are afraid of their side effects on the kidneys and liver after many years on therapy? Can the early use of insulin can preserve the islet cells, since type 2 patients have gradual decreased islet cell function for secretion of endogenous insulin? I have read that approximately 50% to 60% of it remains at the time of diagnosis?
It is true that there is a loss of beta cell mass with type 2 diabetes. Whether early use of insulin, rather than the later use usually offered patients, will help preserve function is not known. You have a good record for your hemoglobin A1c level. Outcomes for diabetes, both microvascular and macrovascular disease, have been tied to this number. It is possible to have more trouble with fasting glucose over post-meal glucose. For those patients, you might try a long-acting insulin. However, the frequency of hypoglycemia might be greater than if you used metformin. Metformin is helpful in suppressing the fasting glucose and does not cause hypoglycemia or weight gain. However, you do need to use caution with kidney function, liver function, and heart function.
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