A few days ago, my 47 year old husband was diagnosed with type 2. diabetes and started on Glucophage, 500 mg, once in the morning. However, his glucose levels were still very high (300s mg/dl [16.7 mmol/L]), so today the physician assistant put him 10 units of insulin in the morning along with another pill (Amaryl) and the Glucophage. The physician assistant wants to see him again in a few days with results of testing four times daily. How does this treatment sound to you?

It sounds reasonable. One of the problems faced by patients with type 2 diabetes is what the initial treatment should. It is very common to have a rather high sugar up front, have some resistance to the sugar come down with a single agent, and later on be treated effectively with that single agent. The reason for this is a condition called glucose toxicity.

Glucose toxicity refers to the idea that high sugars suppress the ability of the cells that make insulin to make it. It is only after the high sugars are lowered that you may gain enough responsiveness from your own body to respond to a single agent. The addition of insulin and Amaryl [glimepiride] in addition to the Glucophage [metformin], is to get your husband’s insulin-producing cells to respond.

JTL