I have had type 2 diabetes for 15 years, and I am on 24 units of Mixtard insulin in the morning and 16 units at night. My blood sugars at present are 103 mg/dl [5.7 mmol/L] fasting, and 203 mg/dl [11.3 mmol/L] after meals. Is there any better medication that would avoid insulin? I also have high blood pressure with a reading of 150/90.

First, the American Diabetes Association has adopted a recommendation for blood pressure control where the goal is a blood pressure less than130/80.

Second, my interpretation of the question centers around whether there are other medications that would be superior to insulin for the treatment of type 2 diabetes. No study has shown that oral agents are superior to insulin in the treatment of type 2 diabetes. Although the question has been raised as to whether insulin therapy, especially in high doses, is associated with accelerated vascular disease, there is no conclusive data to show that. In fact, several tight control studies in patients with type 1 diabetes have shown there is a tendency toward decreased vascular events (stroke, heart attack) with intensive insulin therapy. There is also data from trials with patients who have type 2 diabetes where tight control did not result in an increase in vascular events. Only one study, the VA Cooperative Trial, showed a tendency for more vascular events in patients treated with intensive insulin therapy. However, this was a pilot study.

You may have a question about whether you can be treated with oral agents to allow yourself to be withdrawn from insulin therapy. That may be true. However, that strategy is filled with problems. Your diabetes has gone on for a long time. You may not have enough capacity to make insulin. Similarly, you may respond to oral agents, but not to the point that you have as good a control as being on insulin. There is the question regarding whether you should be on a different regimen. My understanding is that you are on an insulin regimen using a commercially available mixture of insulin. There are times when it may be better to mix various doses of insulin from different vials of insulin (for example, from NPH + regular insulins), rather than using the strict ratio found in the commercially available product. This will allow you more flexibility.

Finally, any treatment should be followed with daily monitoring and periodic measurement of the hemoglobin A1c in order to assure treatment goals.

JTL