Hello XXXXXXX

Thankyou for posting your query on XXXXXXX

Assuming you have Type ll diabetes, your requirement of insulin is very high. The reasons I could think of could either be of the following:

1) Severe Insulin resistance
2) Type 1 diabetes
3) Brittle diabetes
4) Inappropriate insulin dosages
5) Diabetes secondary to pancreatic/endocrine abnormality

I would like you to provide me with following inputs.

Have you ever been in ketoacidosis?
How many times have you been admitted due to high sugars?
Are you sure you don't have Type 1 diabetes as you seem to have diabetes since the age of 22. Type 2 diabetes is quite rare at this age, though not impossible.
Do you have any other conditions like hypertension, pancretitis, thyroid, adrenal or any other endocrine abnormalities etc apart from diabetes?
Are you on any other medications apart Insulin and Glyciphage G2 Forte, especially steroids?
What is your age? Are you overweight?
What were the symptoms you experienced when you were diagnosed as diabetic for the first time? How much were the sugars then?
What are your current blood glucose readings?
What time do you take the insulin and the tablets?
What is your height and weight?
Any other specific investigations that were suggested to you and has come out positive?

Sorry to bother you with so many questions but your inputs will be useful for me to answer your queries better.

To sum it up, you need more meticulous blood glucose monitoring and insulin dose adjustments. I will be available to answer your follow up queries

Regards,

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Hello,
Thanks for reverting back.

It seems like it started with Type 1 diabetes, but now there's also an element of Type 2 in it (Insulin resistance). I would suggest following investigations (if you haven't already went through them) which would help your physician judging the situation more deeply:

GAD65 antibodies, Anti Insulin antibodies, Anti islet cell antibodies, C-peptide (fasting and post-meal), Serum Insulin levels (Fasting and post meal), CT-scan for ruling out pancreatic abnormalities, Serum Lipase and amylase, Thyroid function tests.

Coming to blood glucose control:

You need to monitor your glucose levels 5 times a day for few days (not just fasting and postmeal). You need to measure it for fasting, post- breakfast (pre lunch), post-lunch, pre-dinner, post-dinner, 3 am.
If you keep the record for the above values with a glucometer at home, it will be easier for your diabetologist/physician to adjust the dosages and titrate the medicines.

I'd suggest trying out voglibose, sitagliptin and low dose pioglitazone (in addition what you are taking) under the guidance of your physician.

Also, adding a premixed insulin (30/70 or 50/50) before lunch, in addition to the current regimen should bring the sugars down considerably.

Last but not the least, remember, if your blood glucose levels are in acceptable limits, it would avoid complications due to hyperglycemia in the future.

Hope my answer is adequate and helpful to you.

Please accept my answer if you do not have further queries.

Wish you Good Health.

Regards.

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Hello,

Thanks for reverting back.

The medications and the dosages will be determined once you monitor your sugars at home (5 times a day as suggested in my previous post). Insulin could either be 50/50 before breakfast and before lunch and 30/70 before dinner. Or either 30/70 or 50/50 before all three meals.

One cannot predict the sure shot dosages without monitoring. It's only after dose titration and meticulous monitoring, one can arrive at an appropriate insulin dosage. This can be done only under a guidance of a good physician. Furthermore, the insulin requirement might come down once rest of the oral tablets are added.

I suggest you get any standard available glucometer in the market and start monitoring at home on your current medications and insulin. After 3 days of readings in the prescribed format, show them to your physician and ask about afternoon insulin dosage (it varies from person to person). With him, you should also discuss about rest of the oral tablets as mentioned by me in the previous post.

To sum up:

1) Monitor sugars at home as suggested in the specific format for atleast 3 to 5 days on your current medicines and dosages.
2) Discuss them with a good physician and ask him to make appropriate changes in the tablets.
3) Discuss an appropriate insulin dosage to be added before lunch after going through the glucometer readings.

I hope, I have answered your query. Please accept my answer in case you have no follow up queries.

Wish you good health.

Regards.

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