June 10, 2003
Daily Care, Type 2
Question from Westbengal, Darjeeling, India:
I have type 2 diabetes treated with glipizide and metformin, and on a single day, my sugar level fluctuates drastically from 70-385 mg/dl [3.9-21.4 mmol/L]. My C-peptide level is 3.3, and my hemoglobin A1c is 7.8-8%. I also have high blood pressure. I have disturbed sleep, even though I take medication every night. My daily diet consumption is 1000 to 1200 calories per day, I am 5 feet 6 inches tall, and weigh 72 kilograms. Even when I eat only vegetables with almost without carbohydrate diet, my sugar level does not change. Frequently, after exercise, my sugar level elevates. My sugar level usually drops low at about 3:00 pm every day. I have been told that my diabetes is “brittle”. I don’t feel thirsty or have frequent urination. When my sugar is high, the urination is suppressed and when it’s low, the urination becomes frequent.
I have no access to an physiologist or endocrinologist, and my case is worsening day by day.
Answer:
It sounds like you need a consultation with a certified diabetologist even if this is some distance from your home. You may need insulin and not just pills if your restricted diet and medications in combination are not controlling your blood sugar levels.
SB
[Editor’s comment: It’s unclear what doses of diabetes pills you are presently on. You might do better on larger doses of metformin (which does not by itself cause hypoglycemia). If you are already on a large dose of metformin, then adding a single dose of longer-acting insulin (Lantus or NPH or Ultralente) seems a reasonable idea (perhaps planning to delete the glipizide, and hence ending up on a program of insulin and metformin). Talk these ideas over with your present physician.
WWQ]
