I am a 40 year old female who has had type�1 diabetes (treated with twice daily NPH and Regular) for more than 10 years, my blood sugars have been high, and I have been advised to take Actos once a day.Should I be taking this medication? Are there any side effects I should be aware of?

The rationale for adding Actos [pioglitazone] to an insulin regimen is to decrease the amount of insulin resistance present — it makes the insulin you take more efficient. The original medication in the category of medications (Rezulin) was taken off the market because of liver toxicity. However, the remaining medications now used appear to have significantly less toxicity. You will still have to have your liver enzymes monitored.

There is some tendency to gain weight. However, any time you improve blood sugar control, you can gain weight. If you have a heart problem, some people have noticed a gain in fluid in the legs. This is not common but should be concerning for people who already have problems with this.

I would also add that I think a twice a day insulin regimen for type�1 diabetes is not optimal. I would recommend speaking with your physician about a more aggressive insulin regimen as well.

JTL

[Editor’s comment: A more aggressive program for type 1 diabetes would include frequent blood sugar monitoring, carbohydrate counting, regular exercise, and either a basal-bolus insulin program or an insulin pump.

WWQ]