February 5, 2003
Daily Care, Type 2
Question from New Castle, Pennsylvania, USA:
I am a 58 year old woman who diagnosed with type 2 diabetes 16 years ago, and my disease has progressed to the point that I now require both insulin and metformin. Approximately a year ago, I was prescribed Humalog to control high postprandial blood sugar readings. Three months ago, I started a regimen of Lantus (insulin glargine) with Humalog at mealtimes and metformin twice a day. I was told by my physicians assistant not to be concerned about postprandial readings, so I wasn’t routinely checking my blood sugar after meals. However, I decided to begin postprandial testing, and my two hour postprandial readings have been averaging 175-200 mg/dl [9.7-11.1 mmol/L] after breakfast, and 100-140 mg/dl [5.6-7.8 mmol/L] after lunch and dinner.
I’m not sure what’s going on, or what to try next. I keep my carbohydrate consumption between 35 and 50 grams of carbohydrates for each meal. My fasting levels are 90-100 mg/dl [5-5.6 mmol/L], and my last A1c was 6.4%, but I haven’t had one since I began this treatment plan. I began the insulin plus the metformin to control the postprandial readings, and I’m feeling very frustrated. I work very hard to keep my disease controlled with diet, exercise and medication, and I am willing to do whatever is necessary to maintain my health.
Answer:
I think what your provider was trying to say is not to tightly target your postprandial blood sugar while you are still trying to get the fasting and pre-meal blood sugars down. I am frequently asked whether postprandial sugars or pre-meal sugars are more important. What I say is that both are important. However, you probably have to get the pre-meal sugars on target before you can really focus on the postprandial blood sugars. A good postprandial sugar is less than 140 mg/dl [7.8 mmol/L] so you are not far off. A new hemoglobin A1c would be helpful here but I think your overall regimen is not far off.
Hang in there. You are doing well. Unfortunately, type 2 diabetes behaves like this, with the sequential addition of more medications. You may want to increase your Humalog with breakfast just a little. However, before making any changes, please check with your provider.
JTL
