January 7, 2003
Diagnosis and Symptoms
Question from Dallas, Texas, USA:
Every winter since diagnosis, I have had an episode of elevated blood sugars which I have difficulty getting down. I wake up high (sometimes over 200 mg/dl [11.1 mmol/L]), and by the end of the day, I usually have it down. Sometimes it doesn’t come down to acceptable levels, and I feel lousy when the sugars are high. I take metformin and Glucotrol, and my doctor increased the Glucotrol to 5 mg, but the morning after that, the sugars were even more elevated so I went back to my previous dose. I don’t know why this happens in the winter ( usually December/January). It just seems that the medicine doesn’t work as well, like the insulin resistance is worse, and, when I increase doses, it seems that the sugars go higher.
My last hemoglobin A1c was 6.8%, and they have been in this range since diagnosis, except at the end of these elevated periods where they will be about 7-7.5%. In the past, when the sugars come down, they do so pretty quickly — within a few days — and then stay okay spring, summer, fall.
Since I am a thin female (5 feet 5 inches tall, 110 pounds), am I developing type�1 diabetes? How long does it take to lose control — for the beta cells to fail? Every time one of these episodes occur, I wonder. Can they fail within a period of a few days/weeks?
Answer:
It is possible that the winter brings a decrease in physical activity and an increase in eating with the holidays. Of course this is conjecture, but it would explain your seasonal change in glucose control. These changes increase insulin resistance. If this pattern has been consistent, I would consider asking your physician to increase your medication during this time. One day is not enough to determine whether this intervention is adequate.
I understand your concern about requiring insulin. It is a real concern. Fifty percent of all patients with type�2 diabetes eventually need insulin. However, it is my opinion that whatever is required for control of blood sugar should be used.
JTL
