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Question:

From a physician in India:

I have a patient with type 2 diabetes who is on a maximum dose of oral agents. However, his blood glucose monitoring shows an increasing trend of blood sugars. What next?

Answer:

If your patient is taking the maximum amount of oral hypoglycemic agents, the next obvious choice would be to treat with insulin. However, I guess I would ask which oral medications are being taken. It is now very common in the U.S. for patients with type 2 diabetes to be on a combination of multiple oral medications.

In addition, it would be helpful to have a more quantitative and detailed indicator of blood sugar elevation. If the sugars are markedly elevated above target blood sugars, and if the hemoglobin A1c is greater than 1% above the normal range, insulin would still likely be the next best therapy. The type of insulin therapy could range from NPH or Lantus as the long-acting insulin with Humalog. NovoLog, or Regular as the short-acting insulin.

JTL

[Editor's comment: Also, if the patient is indeed on maximal doses of several diabetes pills, there is a decision to be made about insulin therapy: whether to add insulin therapy while maintaining the oral agents (in which case a single injection of insulin is usually added), or switching completely (discontinuing the pills when starting multiple injections). Either way is acceptable, and again the choice depends on several factors. WWQ]

DTQ-20030805080613
Original posting 17 Aug 2003
Posted to Daily Care and Type 2

  
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Last Updated: Tuesday April 06, 2010 15:09:48
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