June 30, 2001
Daily Care
Question from Germany:
I am 65 years old, and ten years ago I had my first symptoms of diabetes and was put on a sulfonylurea pill. Developing diabetes was a big surprise because nobody in my family has it, and I never was overweight. After about a year, I was put on twice daily 70/30 insulin, but, despite all my efforts with regard to meal planning and checking my blood sugars, my diabetes is more and more labile, my hemoglobin A1c is between 8 and 9%, and my doctor continues to tell me that I have to be more careful. How? Has anyone experienced similar problems? What can I change?
Answer:
I think you may have a type of autoimmune diabetes called Late-onset Autoimmune Diabetes of Adulthood (LADA). A glucagon test might be indicated at this stage to assess whether you need more insulin or an intensified regimen. Premixed insulins don’t work very well, and we always ask LADA people to try to cope with an intensified insulin regimen based on Regular (or Humalog, or Novolog) insulin before each meal and NPH, Ultralente or Lantus (insulin glargine) at bedtime.
MS
