May 28, 2005
Daily Care, Type 2
Question from Joshua, Texas, USA:
I am a 49 year old female who, until about two years ago, had hypoglycemia most of her life. About two and a half years ago, the doctors started testing for diabetes. I now have type 2 diabetes.
We tried diet and exercise, but that didn’t work. I was put on metformin, 500mg twice daily. That made a difference, but not for long. They added Glyburide 2.5, one tablet in the morning. I did that for a few days and the result was sugar bottoming out all at once, with no warning. I cut it down to half in the morning. That seems to help a little more, but my sugars are still running in the 200 to 300 mg/dl [11.1 to 16.7 mmol/L] range. My sugar readings look like a huge roller coaster ride with all the ups and downs and never read steady for more than two hours. I’m having headaches when it gets too high and also when it bottoms out so fast.
Do I need to be on insulin? If so, how do doctors make that determination? Are there specific blood sugar readings that you go by and, if so, what is the cut off point from oral medications to insulin? I’m afraid to get too far from the house because I never know from one minute to the next what is going to happen. At this time, I have recently moved and have no doctor or health insurance. I’m asking so I can decide if I need to get help through the Emergency Room somewhere or I can take my time finding the right doctor for me. Am I in trouble?
Answer:
It is not good to have your blood sugars high and then low. It leads to overtreatment of the lows that cause rebound highs. The first thing you need to think about is keeping a regular schedule with regular monitoring and eating similar amounts of food. Variability in blood sugars may result from eating at odd times. Highs can occur with too much and lows can occur when you go too long without eating. In addition, you need to find a physician to help you. There is no question about it: you need education about self-care of diabetes and you need guidance on the correct medication to take.
When insulin therapy is required, it is usually only after pills have not worked. Laboratory monitoring with the A1c is also very important. This number gives you the average daily blood sugar over the previous three months. You can only have this checked when you are working with a physician. Poor control over a protracted period of time does lead to complications from diabetes, so, there is some importance to having this taken care of in a timely manner.
JTL
