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June 21, 2003

Daily Care, Type 2

Question from :

Sun City, Arizona, USA: I am 5 feet 8 inches tall, weigh 145 pounds, and I am slender with a small-boned body structure. I am moderately active, and I was diagnosed with type 2 diabetes during a routine physical two months ago. I had a fasting blood sugar of 175 mg/dl [9.7 mmol/L] and an A1c test was 8.6%. After a week of monitoring blood sugars, I started taking a morning dose of 5 mg Glucotrol XL because my sugars were over 200 mg/dl [11.1 mmol/L] frequently, even though I have made a serious effort to eat correctly. My morning fasting blood sugars remained high (140-160 mg/dl [7.8-.9 mmol/L]), so two weeks ago, my medication was changed to 2.5 mg in the morning and 2.5mg prior to the evening meal. However, the morning readings remained high and even higher reaching 165 -225 mg/dl [9.2-12.5 mol/L], so several days ago, my doses were were changed again and now I am 2.5 mg in the morning and 5 mg before dinner, but my fasting readings are still in the 150-170 mg/dl [8.3-9.4 mmol/L]range. I am not feeling well and experiencing severe headaches in the morning. I have neuropathy in my feet, and I am very slow to heal if I injure myself. I seem to have all of the secondary symptoms actually. Please advise me as to a possible change of treatment, doctors, or approach to this problem.

Answer:

It may be that your medication has not been advanced as aggressively as it might have been. You do not have to split the dose of Glucotrol XL like that since it is an extended release preparation and can be taken once a day. Often, once the sugars are lowered into the normal range, the beta cells in the pancreas become more efficient at making insulin.

If you are slender and do not need to lose weight, you can still benefit from improving your level of exercise. Given your age, it is less likely that you have been incorrectly classified with type 2 diabetes, rather than type 1 diabetes.

JTL