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May 10, 2002

Daily Care, Diagnosis and Symptoms

Question from Virginia Beach, Virginia, USA:

Last year, I lost part of my pancreas and all of my spleen to a benign tumor, developed diabetes, and the surgeon told me to take glyburide daily if my fasting level is over 126 mg/dl [7 mmol/L], but my regular doctor said not to unless it gets over 200 mg/dl [11.1 mmol/L]. What is the safe level? What type of diabetes do I have?

Answer:

Without enough functioning endocrine tissue remaining in the pancreas, you would be categorized as having what has been called “secondary diabetes.” [See Classification and Diagnosis of Diabetes.] I think you need to think about having tighter control than having sugars less than 200 mg/dl [11.1 mmol/L].

There are several ways of determining control, and one of them is with blood sugars monitored at home. Another important test is hemoglobin A1c which allows for determining your average daily blood sugar over the previous three months (so it looks at the big picture). To minimize the risk of complications, it is suggested you keep the hemoglobin A1c less than 1% above the normal range for the lab performing the test.

JTL

[Editor’s comment: Given the fact that your pancreas may no longer be able to produce sufficient insulin, it may need to be replaced by injection. Glyburide [a pill for Type 2 diabetes] merely stimulates the beta cells to make more insulin. So, if there aren’t enough of them, it won’t work.

Please discuss the need for tighter control and treatment options with your physician. If he/she is unwilling to listen, ask for a referral to an endocrinologist.

SS]