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Question:

From California, USA:

I'm a 41-year-old female, and my gynecologist had me do a two hour glucose tolerance test. The fasting and first reading were 173 mg/dl [9.6 mmol/L], and the two-hour reading was 285 mg/dl [15.8 mmol/L]. Thus, I was diagnosed with type 2 diabetes.

All the test results were to be sent to my primary care physician, and when I went to see him, he only had the two-hour result and prescribed Glucophage which he wanted me to start taking before I saw an endocrinologist and had the chance to discuss any treatment plan. It has been another weeks since the glucose tolerance test, and I have not had my blood glucose checked recently. In the meantime, I have really watched my diet, started an exercise plan (30 minutes --five times a week, and have lost 16 pounds.

I explained this to the primary care doctor but I could tell he wasn't listening to me. I'm uncomfortable starting this medicine without first seeing the endocrinologist. I am also awaiting the insurance paperwork to get my glucose meter. Is starting this medication is the right thing to do? My goal is to manage the diabetes through diet and exercise and try to avoid any medication. Am I making things worse by holding off on the medication until the endocrinology appointment?

Answer:

Losing weight is always the best way to control early type 2 diabetes and if that doesn't work, go to oral hypoglycemic agents. The question is, are your blood sugars getting better as you lose weight or are they getting worse? It is also possible that you are slowly developing type 1 diabetes, and you are losing weight not only because you are dieting, but because you need some insulin. Just because you are 41 does not mean that you definitely have type 2 diabetes. You might have slowly developing type 1 diabetes that requires insulin [Late-onset Autoimmune Diabetes of Adulthood].

It sounds like you need to be checking your blood sugar several times a day and testing your urine ketones. (If you are losing weight and spilling ketones, excessive dieting and Glucophage [metformin] may make you sicker).

It sounds like you either have to find a new primary care doctor, find your own endocrinologist, or purchase urine ketone strips and a meter out of pocket. Then, try to lobby your insurance to reimburse you while you are waiting for a referral. (You don't need a prescription to buy a meter and urine strips; you only need a prescription to get reimbursed.) You can buy the cheapest meter on sale at your local drug store, on-line, or through the mail.

If you become nauseated or start to vomit or become more thirsty and notice that you are urinating more, go to an emergency room to make sure you don't need insulin right away.

TGL

Additional comments from Dr. Jim Lane:

Glucophage has been used in clinical trials as a preventative therapy for type 2 diabetes. It has a low frequency of causing serious low blood sugars. From that standpoint, it would be a relatively low risk, provided you have no kidney, liver, or heart problems (where Glucophage is contraindicated for safety reasons).

From a treatment standpoint, you really need to get that meter so you can see what your blood sugar levels are throughout the day and see how they are altered or changed by the diet and exercise interventions you are using. Then, if you do not reach your goals, you could always start the Glucophage. The big issue here is there is no good reason for holding up getting a glucose meter. Glucose monitoring is a standard part of clinical care. You could get the meter in a short time and be on your way with objective information to guide your course.

JTL

DTQ-20020807195105
Original posting 8 Oct 2002
Posted to Daily Care and Type 2

  
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Last Updated: Tuesday April 06, 2010 15:09:38
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