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Why is my wives sugar levels not improving inspite of taking insulin?

Q: My wife is a NIDDM patient. She was under Glynase and Glyciphage for more than 6 years. Of late her sugar level has increased to > 240 (FBS) and 300 (PPS). Our doctor has prescribed Wosulin 12 units in morning and night with Glizid 80 mg in the noon. Still even after taking insulin the sugar levels especially FBS has not come down to less than 190. She has been taking insulin since 3 weeks. She has also undergone CABG 8 years back.

A:The issue is insulin in Type 2 DM (NIDDM). A large number of patients with Type 2 DM need insulin especially 5-10 years after diagnosis. Oral agents like glynase are effective only if there is some endogenous secretion of insulin but as the diabetes advances there is absolute insulin deficiency and at this point of time, these patients need insulin. For insulin therapy there are options available like once a day glargine (Lantus), once a day Insulard, twice a day premixed (Mixtard/Humulin 30:70). According to my opinion there is still scope for oral medications in case the doses of glynase and glucophage were not optimal. I will suggest Glynase XL 10 mg twice a day with Glucophage 1 gm twice a day along with strict diet and exercises. In case targets are not achieved in 15 days time (FBG 80-120 and PP<180) then glucobay 50 mg thrice a day which can be increased to 100 mg thrice a day. If still glycaemic control not achieved then add either bed time Insulatard 12 units a day or Lantus 12 units in morning. Uptitrate the doses according to the response till you achieve targets.

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