Can Switching to Insulin Help Manage Post-Meal Blood Sugar Levels?

Q: Can Switching to Insulin Help Manage Post-Meal Blood Sugar Levels?

Hello： 1. There are many factors that contribute to postprandial hyperglycemia, and there are various ways to manage it. Insulin is one of the methods. I am not aware of the specific regulations regarding insulin under the health insurance system. 2. Your phys

If the effect of using metformin after meals is not satisfactory, can insulin therapy be considered?

Hello, Doctor.
Thank you very much for your response.
I have had diabetes for 2 years, with an initial HbA1c of 6.6 and a fasting blood glucose of 142.
I have been using Metformin for two years.
Additionally, my bilirubin has increased from 1.5 to 2.2, and I have been using the National Health Insurance-covered medication, Belarck, for three years.
My usual fasting blood glucose is around 110-120, and my HbA1c has gradually risen from 5.6 to 6.1.
I have difficulty gaining weight and monitor my blood sugar regularly, so I am cautious about my carbohydrate intake.
I maintain a regular lifestyle and exercise, and I attend follow-up appointments on time.
Recently, I have noticed that my postprandial blood glucose (after breakfast and lunch) often peaks above 200, and two hours after meals, it is around 170-180, sometimes persisting for 3-4 hours after eating! I suspect that my pancreas may be deteriorating, leading to insufficient insulin production.
I would like to ask the doctor:
1.
Can I switch to insulin under the National Health Insurance? (It seems that there is a regulation requiring an HbA1c over 7 for this? Does exceeding postprandial levels count?)
2.
Will the gradually increasing bilirubin affect the efficacy of Metformin on the liver? Would switching to insulin be a better option?
3.
How should I communicate with my doctor about adjusting my postprandial medication?
Thank you for your response, Doctor.

Da Ke, 40~49 year old female. Ask Date: 2023/06/10

Dr. Lin Jianliang reply Internal Medicine

Hello: 1.
There are many factors that contribute to postprandial hyperglycemia, and there are various ways to manage it.
Insulin is one of the methods.
I am not aware of the specific regulations regarding insulin under the health insurance system.
2.
Your physician will likely continue the medication, which should not have a significant impact.
Insulin can be adjusted, and medications can also be modified.
You can discuss this with your physician.
3.
You can inform your physician about your dietary habits and your self-monitored blood glucose levels, as well as any concerns you may have.

Reply Date: 2023/06/10

More Info

Switching to insulin can indeed be a beneficial strategy for managing post-meal blood sugar levels, especially for individuals with diabetes who are experiencing challenges with their current medication regimen. In your case, it appears that despite using Metformin for two years, your post-meal blood sugar levels are still peaking above 200 mg/dL, which indicates that your current treatment may not be adequately controlling your blood glucose levels.

1. Eligibility for Insulin Therapy: In the United States, the decision to switch to insulin therapy is typically based on several factors, including the patient's blood glucose levels, the presence of symptoms, and the overall management of diabetes. While it is true that some insurance plans may have specific criteria for coverage of insulin therapy, such as requiring an A1C level above 7%, your situation may warrant a discussion with your healthcare provider. Post-meal blood sugar spikes, like the ones you are experiencing, can be a valid reason to consider insulin, even if your A1C is not above the threshold. It is essential to communicate your concerns about your blood sugar levels and how they are affecting your daily life during your appointment.

2. Impact of Elevated Bilirubin Levels: Regarding your bilirubin levels, it is crucial to monitor liver function when using Metformin, as it is primarily processed by the liver. Elevated bilirubin levels could indicate liver dysfunction, which may affect how Metformin works in your body. If your liver function is compromised, it could lead to an increased risk of side effects from Metformin. Switching to insulin may be a safer option if there are concerns about liver health, as insulin does not rely on liver metabolism in the same way that Metformin does. However, this decision should be made in consultation with your healthcare provider, who can evaluate your liver function tests and overall health status.

3. Communicating with Your Doctor: When discussing your medication regimen with your healthcare provider, it is essential to be open and honest about your experiences. Here are some tips for effective communication:
- Prepare for Your Appointment: Write down your blood sugar readings, any symptoms you have experienced, and your concerns about your current treatment. This information will help your doctor understand your situation better.

- Express Your Concerns: Clearly articulate your worries about your post-meal blood sugar spikes and how they impact your daily life. Mention any lifestyle changes you have made, such as diet and exercise, and how they have not led to the desired outcomes.

- Ask Questions: Inquire about the possibility of switching to insulin therapy and the criteria for insurance coverage. Ask about the potential benefits and risks of insulin compared to your current medication.

- Discuss Monitoring: Talk about how you will monitor your blood sugar levels if you switch to insulin and what adjustments may be necessary based on your readings.

In summary, switching to insulin could be a viable option for managing your post-meal blood sugar levels, especially given your current challenges with Metformin. It is essential to have an open dialogue with your healthcare provider about your concerns, the impact of your elevated bilirubin levels, and the potential benefits of insulin therapy. By working together, you can develop a personalized treatment plan that effectively addresses your diabetes management needs.

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