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January 28, 2008

Hyperglycemia and DKA, Pills for Diabetes

Question from Pakistan:

My doctor has recommended that I take one 4mg Amaryl in the morning, one Glucophage in the morning and one in the evening. As he also suggested, I am not eating any sweetened foods. However, when I check my blood sugar, it is high. In the morning, it is around 250 mg/dl [13.9 mmol/L] to 290 mg/dl [16.1 mmol/L] and randomly, it is 350 mg/dl [19.4 mmol/L] to 450 mg/dl [25 mmol/L]. Why is this happening? No one else in my family has diabetes.

Answer:

Without knowing very much about you, I can only comment on some possibilities. First, I would raise the question as to whether your diagnosis is correct. Do you have type 1 or type 2 diabetes? Type 1 diabetes occurs in patients who are thin. Patients are usually under 30 years of age, but some have been diagnosed at older ages. Patients come from families where the diagnosis skips generations so you may not find others with the disease in the family history. Patients have low C-Peptide levels and positive autoimmune markers that can be ordered by the attending physician. If a person has type 1 diabetes, but they are not treated with insulin, the blood sugars will not get better. The other possibility is that you have type 2 diabetes, but are having secondary failure where insulin may be required anyway. I would recommend you speak to your physician as these numbers you are quoting are very high and I am concerned that you may need more aggressive therapy.

JTL