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April 12, 2007

Insulin, Type 2

Question from Jakarta, Indonesia:

I have mild diabetes. My A1c is 5.5% and my two hours postprandial average is 168 mg/dl [9.3 mmol/L], but there is something that make me worry: my fasting blood sugar is rather out of control. Its average is 120 mg/dl [6.7 mmol/L] to 135 mg/dl [7.5 mmol/L] without exercise in the morning. If I exercise, it's usually 107 mg/dl [5.9 mmol/L] to 117 mg/dl [6.5 mmol/L], depending on how long I do this exercise or workout. I usually do this around 30 to 45 minutes. Is this common if I use a basal insulin analog like NovoMix 70/30 to make it in range or it will give me some adverse reaction besides hypoglycemia?

Answer:

The high blood sugar in the morning is usually a function of long-acting basal insulin before breakfast. If your blood sugar rises high after breakfast, this is a result of not enough short-acting bolus insulin. Since the commercial mix has both basal and bolus insulin, it is important to determine which component needs to be altered. For this reason, I am less a fan of mixed insulins because you cannot individually titrate the insulins.

JTL