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July 6, 2004

Hyperglycemia and DKA, Type 2

Question from Washington, USA:

I have been a diabetic for four years and have not been on insulin. Lately, I have been running very high, 332 mg/dl [18.4 mmol/L], 272 mg/dl [15.1 mmol/L], and 250 mg/dl [13.9 mmol/L]. Some of my lower reading have been 191 mg/dl [10.6 mmol/L], 175 mg/dl [9.7 mmol/L], and 182 mg/dl [10.1 mmol/L]. I have noticed that I am higher either before lunch or right before dinner and when I go to bed. I have asked my regular doctor this question and he won't help me. I need some sort of insulin, perhaps short acting. I work in a day care center and work weird shifts. When I get up in the morning, my blood sugars have been 115 mg/dl [6.4 mmol/L], 119 mg/dl [6.6 mmol/L], and 124 mg/dl [6.9 mmol/L], but they then begin to rise. I'm eating more because I'm hungry and drinking more because I have been thirsty. What should I do? I'm 23 years old. Diabetes runs in my family. I have two uncles on both sides of the family who have type 1, a cousin on my dad's side who has type 1, my dad's dad had type 2 and his mom also has type 2. I'm getting sick and tired of being told I don't need insulin when I do.

Answer:

First of all, it sounds like you have type 2 diabetes. Your lower blood sugars in the morning suggest you can recover from the higher values. However, when you eat, they go up. I am not sure you indicated to me what medication you might be on, even if it is not insulin. All oral anti-diabetes medications may help with post-meal blood sugars. Clearly, your blood sugars are way too high to remain untreated. Make sure you discuss these values with your physician. Demand instruction and care to get sugars down to target values. If anything, you should be on an oral agent, diet, and exercise regimen. If you cannot get treated appropriately, see another physician. I agree that you need to be an advocate for your own care.

JTL