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July 17, 2005

Insulin

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Question from Zanesville, Ohio, USA:

I take 260 units of NovoLog 70/30 insulin and I was wondering if there were other insulin treatments or something I should try. I feel that 260 units is a lot of insulin.I am 6 feet tall and weigh 315 pounds. My blood sugars run from 125 to 245 mg/dl [6.9 to 13.6 mmol/L]. I test four or more times a day.”

Answer:

From: DTeam Staff

Your insulin dose is very high. It is a result of marked insulin resistance in your body. Your weight has a lot to do with this. It will be very important for you to lose weight by whatever means is available to you. A loss of 10 to 20 pounds may mean significant decreases in insulin dosing. I would recommend you seek aggressive weight loss therapy to improve your diabetes and overall health.

JS
Additional comments from Dr. David Schwartz:

When looked with absolute numbers, a dose of 260 units insulin is a lot. But, when looked at in context with the Question Writer’s weight of 315 lbs (143 kilograms), the Units per kilogram is 1.8. It does suggest a degree of insulin resistance as noted, but it is not so out of the ranges of rather typical clinical practice.

I agree with weight loss as the most important step. I am not a big fan of pre-mixed insulins, of which your 70/30 is one. If I were your physician and depending on the rest of your history and exam, then there would be strong consideration to changing/adjusting the insulins and adding oral agents as “insulin sensitizers” or those that decrease your liver glucose manufacturing. Talk to your doctor and request a referral to an endocrinologist, if you do not already have one.

DS