June 10, 2003
Daily Care, Type 2
Question from North Pole, Alaska, USA:
I have had type 2 diabetes for 20 years, and until two years ago, it was kept in tight control with diet and exercise even though my weight still remained over 200 pounds. (I have Polycystic Ovary Syndrome). I am now taking 2000 mg of metformin and am still having trouble with high fasting readings of 150 mg/dl [8.3 mmol/L]. My doctor now has me trying Lantus in an attempt to get the fasting down. However, the doctor is an internist with a speciality of oncology. He is very willing to let me be in charge of my diabetes, but both of us are concerned with the “dawn phenomenon”. Any suggestions of how to deal with it would be greatly appreciated. I take lots of blood readings to keep in tight control, and my 2:00-3:00 am readings are usually around 110 mg/dl [6.1 mmol/L].
Answer:
The use of Lantus is a reasonable choice to try and decrease the fasting blood sugar. However, Lantus is peakless. It does not rise to meet the increased blood sugars in the early morning (a result of the so-called dawn phenomenon). Another approach would be to try and give NPH insulin at bedtime. This insulin peaks 8-10 hours after administration and may be just the insulin to decrease the fasting glucose. It will be less potent throughout the rest of the day. However, keep working on diet and exercise. These are still very important.
JTL
