My sister-in-law, who lives with me and has type 2 diabetes (treated with Glucophage and insulin), won’t follow any kind of diet. She increases her insulin to offset her blood sugar, drinks Cokes and orange sodas, and does not exercise. I don’t know what to do. What will the constant increase of insulin do to her? She has the “Apple” figure, is 5 feet four inches tall, and weighs 220 pounds.

When a person, like your sister-in-law, has type 2 diabetes, the problem is usually more than amounts of insulin being made. It is also insulin resistance. Glucophage [metformin] is a useful tool for insulin resistance, but there are additional medicines that are used with that such as Actos [pioglitazone] and Avandia [rosiglitazone] which are more specifically targeted to insulin resistance. If you sister is unable to make enough insulin on her own, injectable insulin is added. Today’s choices include rapid acting insulin for covering food eaten (Humalog and Novolog) along with longer acting insulin to work between meals (NPH, Ultralente and Lantus [insulin glargine]).

You did not mention what type of insulin your sister-in-law is on which is an important piece of her puzzle. In general, when a person does not have diabetes, the pancreas releases rapid acting insulin each time we eat in amounts to cover the food we eat. If we eat a large meal, we produce larger amounts of insulin; small meal, smaller amount. In between meals, we secrete small amounts of rapid acting insulin to keep the blood sugar balanced.

If your sister-in-law is taking rapid acting insulin at meals, it is very appropriate for her to adjust the amount based on the carbohydrate she is eating. This would mimic what her body is trying to do. If your sister-in-law is not using a rapid acting insulin at meals, it is much harder to match the insulin need. Does taking insulin in large amounts cause any problems? Well, if it is the wrong insulin it can increase her risk of low blood sugars as well as increase her chance of gaining weight if she’s eating more than she’s burning in exercise.

I hope that you both will take advantage of seeing a diabetes educator in your area to discuss all the possibilities of diabetes management. If you don’t have one, you can call the American Association of diabetes Educators at 1-800-TEAM UP 4 for a listing.

KS