Managing Poor Blood Sugar Control in Type 2 Diabetes: Is Insulin Necessary?

Q: Managing Poor Blood Sugar Control in Type 2 Diabetes: Is Insulin Necessary?

Dear Ms. <br>Deep White：<br>1. <br>Currently, the common treatment for type 2 diabetes includes dietary control, regular exercise, and medication. <br>Regardless of whether insulin is injected, dietary management and consistent physical activity must be diligently practiced, whic

Poor blood sugar control?

Hello Doctor, I was diagnosed with type 2 diabetes in 2010.
Over the years, my blood sugar levels have remained consistently high due to poor management and adherence to medication.
In July of this year, I underwent tests at China Medical University, where my fasting blood glucose was 270 mg/dL, postprandial blood glucose was 543 mg/dL, and my creatinine level was 0.35 mg/dL.
The doctor advised me to take medication to lower my blood sugar more effectively, as exercise was no longer sufficient.
I have been taking the medication continuously for almost three months (I apologize for not being able to provide the exact names of the medications as I did not keep the prescription).
In November, I returned to a closer branch for a follow-up, where my postprandial blood glucose was 290 mg/dL, and my A1C was 12.9%.
The doctor who reviewed my report directly suggested that I start insulin therapy.
Is this the correct approach? I am quite afraid of the daily injections.
If I strictly adhere to my diet and exercise, is it possible to avoid insulin injections? Currently, I am taking the following medications: once daily extended-release Fluvastatin, twice daily Glucophage (Metformin), once daily Sitagliptin, and twice daily Strocain.

Shen Baise, 30~39 year old female. Ask Date: 2016/12/02

Dr. Xiao Yongxun reply Internal Medicine

Dear Ms.
Deep White:
1.
Currently, the common treatment for type 2 diabetes includes dietary control, regular exercise, and medication.
Regardless of whether insulin is injected, dietary management and consistent physical activity must be diligently practiced, which means making lifestyle adjustments.
This is essential to prevent macrovascular diseases, including cardiovascular diseases, cerebrovascular diseases, and peripheral artery diseases; as well as to avoid microvascular complications, such as retinopathy, neuropathy, and nephropathy.
Additionally, in the short term, it can help prevent diabetic ketoacidosis and hyperglycemic hyperosmolar non-ketotic syndrome.
2.
If oral medication is not effective, it is recommended to initiate insulin therapy as soon as possible to avoid complications from hyperglycemia.
Many diabetes experts in the medical field even suggest that, if feasible, insulin therapy should begin immediately upon diagnosis of diabetes for better outcomes.
Otherwise, the body's tissues and organs may be "soaked in sugar," making it difficult to avoid significant acute or chronic complications in the short term.
3.
The medications you are using are as follows:
a.
Fluvastatin XL can lower cholesterol levels.
b.
Glucomet® contains 500 mg of Metformin and 5 mg of Glyburide; theoretically, it can effectively lower blood glucose levels.
c.
Sitagliptin is a DPP-IV inhibitor that can slow down the rapid degradation of insulin.
d.
Strocain is an ingredient in gastrointestinal medications.
All of these are commonly used and effective medications.
1.
Due to the limited information provided, I can only say: unless there is very effective and reasonable dietary and exercise control, it may be necessary to rely on insulin injections to quickly bring blood glucose levels under control.
2.
I sincerely recommend that you communicate and discuss in detail with your attending physician to avoid unnecessary health issues or harm.

Reply Date: 2016/12/02

More Info

Managing blood sugar levels in individuals with Type 2 diabetes can be a complex process, especially when faced with consistently high readings. Your situation, with fasting blood glucose levels reaching 270 mg/dL and postprandial levels soaring to 543 mg/dL, indicates that your diabetes is not well-controlled. The recommendation from your doctor to start insulin therapy is a common and often necessary step in managing diabetes when oral medications alone are insufficient.

Understanding Insulin Therapy
Insulin is a hormone that helps regulate blood sugar levels by facilitating the uptake of glucose into cells for energy or storage. In Type 2 diabetes, the body either becomes resistant to insulin or does not produce enough of it. When blood sugar levels remain high despite oral medications, insulin therapy can provide the necessary support to bring those levels down to a safer range.

The Role of Lifestyle Changes
While insulin can be effective in controlling blood sugar, lifestyle changes such as diet and exercise are crucial components of diabetes management. However, it’s important to recognize that these changes may not always be sufficient on their own, especially in cases of severe hyperglycemia.
1. Diet: A balanced diet that focuses on whole foods, low in refined sugars and carbohydrates, can help stabilize blood sugar levels. Monitoring carbohydrate intake and spreading meals throughout the day can also be beneficial.

2. Exercise: Regular physical activity can improve insulin sensitivity and help lower blood sugar levels. However, given your current blood sugar levels, it may be challenging to engage in vigorous exercise without first addressing the hyperglycemia.

The Decision to Start Insulin
Your doctor’s recommendation to start insulin is based on the need to quickly lower your blood sugar levels to prevent complications associated with prolonged hyperglycemia, such as cardiovascular disease, nerve damage, and kidney issues.
- Fear of Needles: It’s understandable to have apprehensions about insulin injections. Many patients share this concern. However, insulin therapy can be life-changing and may significantly improve your quality of life by stabilizing your blood sugar levels.

- Types of Insulin: There are various types of insulin, including long-acting and short-acting formulations. Your healthcare provider will tailor the insulin regimen to fit your specific needs, which may include a combination of different types.

Can You Avoid Insulin?
While it is possible to manage Type 2 diabetes without insulin through strict dietary control and regular exercise, this is often only feasible in the early stages of the disease or when blood sugar levels are not excessively high. Given your current A1C of 12.9%, it is unlikely that lifestyle changes alone will bring your levels down to a safe range without the aid of insulin or other medications.

Conclusion
In summary, starting insulin therapy is a valid and often necessary step in managing poorly controlled Type 2 diabetes. While lifestyle modifications are essential, they may not be enough in your case. It’s crucial to have an open discussion with your healthcare provider about your concerns regarding insulin therapy and to explore the best approach for your individual situation. Regular monitoring of your blood sugar levels, adherence to prescribed medications, and ongoing communication with your healthcare team will be key to successfully managing your diabetes.

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