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?
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.
[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]
|Return to the Top of This Page|
Last Updated: Tuesday April 06, 2010 15:09:48
This Internet site provides information of a general nature and is designed for educational purposes only. If you have any concerns about your own health or the health of your child, you should always consult with a physician or other health care professional.
This site is published by T-1 Today, Inc. (d/b/a Children with Diabetes), a 501c3 not-for-profit organization, which is responsible for its contents. Our mission is to provide education and support to families living with type 1 diabetes.
© Children with Diabetes, Inc. 1995-2018. Comments and Feedback.