My 65 year old father has type�2 diabetes treated with pills, and, due to lack of medical facilities, he could not properly monitor his sugar levels until now. He has lost 12 pounds in four months and now weighs only 120 pounds with a height of 5 feet 7 inches. At what times should he check his blood sugar? What are the normal readings for fasting and random tests? If the blood sugar level is 180 mmol/L [10 mg/dl] two hours after the meal does he need an increase in his dose? Four hours after a meal, there is a sharp fall in the blood sugar level without increasing the dose. Why? How can he increase his weight?

You raise many questions that really require a physician to participate in the care of your father. I routinely recommend checking both pre-meal and post-meal blood sugars. However, I do not necessarily advise doing them all at the same time. For instance, in patients beginning to intensify blood sugar control, I may start with sugars before meals and at bedtime. Once these are less than 140 mg/dl [7.8 mmol/L], I begin to look at the post-meal blood sugars more critically. Good blood sugar control after meals usually represents a higher degree of control than control of only the pre-meal sugar. I would shoot for a glucose less than 140 mg/dl [7.8 mmol/L] two hours after meals. A loss of weight may represent poor blood sugar control over time.

JTL