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October 14, 2001

Type 2

Question from San Diego, California, USA:

I have type 2 diabetes, and my A1c is in the normal range (5.6%) with diet and exercise control alone, but I find one to three blood glucose elevations per week (up to the 150 mg/dl [8.3 mmol/L] range). My weight is completely normal, and I refuse to try any more diabetes pills due to their side effects. What damage, if any, is likely being caused by post meal and/or bedtime highs? If the A1c is normal, and a patient cannot tolerate pills, is it appropriate to use insulin intermittently for a few weekly spikes?


Since the hemoglobin A1c is what has been correlated with risk of complications. and yours is normal, you are in good shape. Because your A1c us normal, I would not add insulin at the present time. However, I would caution you that the control does not have to stay the same with time. Type�2 diabetes has a plot line and can worsen with duration. Even though you are not using medications or insulin now, that does not mean you may not have to in the future. That is where your monitoring and A1c comes into play.