I am a physician and just started my private practice here in a town in India. My mom has type 2 diabetes and is on glipizide, 5 mg, and metformin, 500 mg. She takes both tablets with both major meals, but her fasting sugars are always on a higher side, i.e. more than 180 mg/dl [10.0 mmol/L]. Her postprandial blood sugar remains below 200 mg/dl [11.1 mmol/L]. If type 2 is mainly due to insulin resistance, is it worth giving glipizide which is an insulin secretagouge? Metformin is taking care of the postprandial sugars. Does my mom require any other oral antidiabetic that instead of causing insulin secretion, which may be normal in my mom, would take care of insulin resistance? Is there any way to find out if she requires the insulin secretagogue? Or, should I increase the dose of the medicines she is taking now?
Given the information, I would consider possibly increasing the metformin, but you should discuss this with her physician. Individuals with type 2 diabetes may have a combination of insulin resistance initially and then insulin deficiency in the later stages of the disease. The combination of a insulin secretagogue and a biguanide such as metformin can be very effective.
Other medications utilized include TZDs such as Avandia (rosiglitazone) or Actos (pioglitazone). These are insulin sensitizers and are extremely effective in treatment. However, one must be aware of the possible side effects for any of the medications and precautions, such as liver disease and heart failure which would limit these medications.
There are cases in which insulin is the preferred treatment, but this does not appear to be the case at this time for your mother.
Last Updated: Tuesday April 06, 2010 15:09:56
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