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Type 2 Diabetes Mellitus.

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I am a 54 year old, type 2 diabetic. I am about 40lbs overweight. I take metformin 1000mg bid and glyburide 5mg bid. My last a1c was significantly higher than past results (usually around 7 or a bit lower). Admittedly, I play fast and loose with my diet. It is my feeling that the higher result was because of my diet. My health care provider does not know this. I have been being a "good boy" since and I hope this is helping. He said that if my next test in April is not lower, he wants me to start on insulin. As I understand it, there is no going back once one is on insulin injections. If the higher a1c is a result of my condition getting worse, do I have any other options before I am forced to commit to insulin?

Category: Diabetologist

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Category: Diabetologist
Dr. J Muthukrishnan is online now

Expert:  Dr. J Muthukrishnan replied 4 Days.


Thank you for choosing DoctorSpring.

If your HbA1C is staying high Insulin will be your best option. You are already on 2 drugs and you are bit loose with your diet. These all make Insulin a great option for you. Insulin is not an 'end' option, but it is the SAFEST and MOST EFFECTIVE option. Drugs are unnatural ways to control the blood sugar. With modern Insulin Pens using Insulin is much easier than taking medications. All most all my patients who shifted to insulin are happy with their choice.

Being said that you DO HAVE options with medications. First and foremost is strong diet control. Next would be adding a third drug like DPP4 inhibitor (Sitagliptin, Vildagliptin etc). With one add on medication and regularisation of diet you can keep HbA1C under control. Diet control itself (make sure you are not getting hypoglycemia attacks) for 2 months can bring down HbA1C. If this fails - consider a DPP4 inhibitor drug. But the best option would be Insulin.

Hope this helps
Feel free to ask followups
Thank you

Dr. J Muthukrishnan
Category: Diabetologist
1. 10th Asia-Pacific Pediatric Endocrine Society  Fellows meeting, Seoul, Korea, Oct 2008
2. Eighth ICMR Course on Genetics and Genetic Counseling – Jul 2008 – SGPGI, Lucknow
3. Annual Certificate Course on Endocrinological Laboratory Techniques at National Institute of Nutrition (ICMR) Hyderabad,India, ( Aug-Sep 2006) 
Fellowship: Endocrinology, Diplomate of National Board, National Academy of Medical Sciences, New Delhi, 2008, Medwin Hospital, Hyderabad
Senior Residency: Diplomate of National Board (General Medicine), National Academy of Medical Sciences, New Delhi, 2002
Residency: MD, General Medicine, 1997-2000, Armed Forces Medical College, 2nd position in University
Medical School: MBBS, Armed Forces Medical College, 1992
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