February 26, 2002
Diabetes Insipidus, Type 2
Question from West London, United Kingdom:
I am 37 years old, I weigh about 220 pounds, and I have type 2 diabetes originally treated with Precose (acarbose) and diet. My control was very good with a hemoglobin A1c average of around 5% until two months ago when I developed DKA [diabetic ketoacidosis]. After that, I was given glipizide initially with no effect, so I was started on twice daily mixed insulin.
I have found that with a little carb control I need 46 units twice a day to get my blood glucoses within recommended range, but I am finding this hard to keep to. If I increase any higher, I tend get hypo symptoms and so need to eat more. The NPH part of the Mixtard 30/70 seems to work very well but the Regular seems not to do much. I seem to remain quite high after eating until about three hours later. I want to eat less (to keep weight control and eventually lower it).
Am I taking a lot of insulin for someone type 2? Is the Mixtard intended as a permanent solution or a stabilizing one? (It is very inflexible). Are there other insulin regimens that I should know about so that I can discuss them with my endocrinologist?
Answer:
For a 220 pound person, the dose isn’t that high, but type�2 diabetes includes insulin resistance. Ask about a drug that helps that (such as Glucophage [metformin], Actos [pioglitazone], or Avandia [rosiglitazone]).
30/70 is commonly used for type 2 diabetes, but obviously you can give long and short acting as mixtures, using separate bottles and mixing as needed in proportions wanted. Rapid acting analogs (Humalog or Novolog) could be used instead of Regular, and you could commit to carbohydrate counting to determine insulin dose. In short, there are lots of choices which will require more work. Are you committed to do more work? If so, ask your doctor to discuss all possible treatment options.
LD
