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January 27, 2003

Daily Care, Type 2

Question from England:

I have had type 2 diabetes for about two years now and have had good control up until three months ago by taking glipizide and some diet actions. I am also on medication for high blood pressure. Lately, however, I have found it difficult to stay in range. it appears that I only have to consume a small amount of food for my levels to raise to between 10 and 15mmol/L [mg/dl]. I also feel very tired most of the time. I have increased my glipizide, but this has had little effect. Other aspects to consider are that I have gained 10 pounds since the cricket season finished. What effect could this amount of gain have on my levels? When I last spoke to my doctor he was aware of the rise in my levels and did consider adding a small amount of metformin but did not do so. Why is he being hesitant How can I tell if my condition is one of not enough insulin being produced or that I'm failing to use what I have got? Am I right to assume that this would direct what sort of tablet I should be taking? What is going though my mind is that if it is resistance I have then should I be pressing for this addition?


It is important to consider that type 2 diabetes changes over time. It is not a static condition that once treated remains similar over time. In fact, 50% of patients with type 2 diabetes end up on insulin at some point in their life. Some do this earlier and some later. There can be conditions that stimulate the change, such as your weight gain. The failure of blood sugars to come down with additional medications is not uncommon. It can also occur relatively fast, even for those with a previous history of good blood sugar control.

Type 2 diabetes is almost universally associated with insulin resistance. The resistance is overcome by a compensatory increase in insulin secretion. However, at some point, and for unknown reasons, the insulin-producing beta cells fail and sugars rise. Sometimes this can be reversed. Other times, a progressive route to insulin therapy is required.

Your next act should be to monitor your sugars carefully, do everything you can to modify your lifestyle in a favorable way, and discuss your progress with your physician. If favorable results, defined as blood sugars within the target range, are not attainable, an increase in medication may be required. This would include adding metformin to your existing medication. I would suggest that your progress should be looked at over a matter of days to weeks, rather than weeks to months.