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December 9, 2005

Insulin, Other

Question from India:

My mom is diabetic. She has been taking insulin for the last 10 years, including long-acting, mixed, bovine, etc. Her sugar level varies between 150 and 200 mg/dl [8.3 and 11.1 mmol/L]. It is usually is around 170 mg/dl [9.4 mmol/L] or so. Her eyes have started blurring also. She takes 30 units of insulin in morning and 40 units in the evening. She is a housewife, but works a lot at home. Her nephrons are okay as yet. If she's taking insulin, why doesn't she have better control? What type of diet should she be on? Are there any other precautions she should take?


For some people who are very resistant to the insulin, they need to use higher doses to get the same response others get at lower doses. This is referred to as having insulin resistance and is a common problem associated with type 2 diabetes. The resistance can be lowered by weight loss (if overweight), exercise, and avoiding overeating at meals. In addition, some medications have been used in conjunction with insulin to improve the response to the insulin. However, it may be more expensive to add additional agents.

I agree that her blood sugar results are too high. I suggest she talk with her physician about increasing the dose of her insulin to reach target of less than 120 mg/dl [6.7 mmol/L] fasting and less than 140 mg/dl 7.8 mmol/L] before meals and bedtime. In the big picture, she should continue to have her eyes and kidneys checked. In addition, she should have her heart checked with good control of cholesterol and blood pressure. The complications to the eyes, kidneys, and nerves are associated with duration and amplitude of glucose levels over time. Anytime is a good time to start to get better blood sugar control. There is no hard rule about how long people go before developing complications. With ten years of insulin therapy, she needs to be watched carefully and have her blood sugars more tightly controlled.