September 26, 2005
Remember that the information presented here is not intended to replace the care of your own doctor. Before making any changes in the management of your own illness, you should consult your physician or other qualified medical professionals.
Question
I have type 2 diabetes treated with 850 mg of metformin twice a day, 8 mg of Avandia, and 40 units of Lantus. However, I still have readings of 200-250 mg/dL [11.1-13.9 mmol/L] in the morning and 450-525 mg/dL [25-29.2 mmol/L] at nighttime. Can you help me? I need to know what can be wrong. Could it be all the stress I have at work?Answer
Clearly, stress can aggravate diabetes control, but I suspect your problem is the progressive nature of type 2 diabetes. This means that sooner or later your pancreas will quit making insulin, and you will need to take short-acting (bolus) insulin as well as the Lantus (basal) insulin.There are other drug options that might be tried (such as Symlin or off-label Byetta or sulfonylureas).
In addition, you should have a review of your meal planning by a diabetes dietitian. If you are not under the care of a diabetes team, ask for a referral.
