Insulin has many actions. If a type 2 diabetic takes insulin and oral medications, can this additional insulin (somewhat excess) enhance other actions as greater fat or protein stores, alkaliosis? How can insulin resistance be corrected if greater fat stores are possible with more insulin?

My blood sugar is never controlled and remains around 270 mg/dl [15.0 mmol/L] fasting. Can living in big, crowded and polluted cities cause persistent hyperglycemia? Lipid levels and other tests are normal. I also feel some unpleasantness, common burning/irritations and acidity on taking insulin (not hypoglycemia). I take 15 units of medium acting insulin and Amaryl 2 mg. Metformin doesn’t suit me.

I will take the questions in the order they are stated. First, you have hit on the problem of insulin therapy in type 2 diabetes. Insulin resistance can be a difficult problem to overcome in patients with type 2 diabetes. The large doses of insulin promote more fat deposition, which increases fat deposition, which increases insulin resistance, which requires more insulin therapy, etc. However, this is not all patients with type 2 diabetes. It has been fairly well settled that patients with type 2 diabetes also have a defect in insulin secretion. It means that in addition to the insulin resistance, there is an inability to secrete insulin on demand. Therefore, patients who have failed at least two oral medications are probably approaching or have developed some inability to secrete insulin at appropriate timing to prevent high glucose levels. The thought is that appropriate timing of insulin therapy will actually help patients with type 2 diabetes reach better control and that insulin therapy should not be delayed till a last resort.

Your second question refers to your specific therapy. Urban settings often impact people in the way they live their lives. For instance, physical activity might be less in an urban setting. Exercise is one of the ways that you can improve your response to insulin and your medications. It also has an impact on your diet, with regard to the foods available and how much you eat. If your blood sugars are in the upper 200s mg/dl [over 15.0 mmol/L], this is obviously not good. You are on a relatively small dose of both the insulin and the Amaryl. Amaryl can be given to doses up to 8 mg per day. I would suggest you intensify your lifestyle and see your physician about changing your medications to help reach your target blood sugars.

JTL