Should Diabetic Patients Rely on Insulin or Oral Medications?

For diabetic patients, is it better to take medication or to use insulin?

My mother has had diabetes for over ten years.
In December of last year, her doctor recommended insulin injections to control her blood sugar.
After the New Year, she did not take insulin for about two weeks, and her blood sugar levels were 148 postprandial and 118 preprandial.
Therefore, the doctor suggested that she no longer needed to take insulin or medication.
However, on Sunday, her blood sugar levels were 196 preprandial and 198 postprandial.
Should she continue with insulin injections? If so, how much should she take in the morning and evening? Or should she switch to medication for control?

Xiao Yao, 40~49 year old female. Ask Date: 2006/02/21

Dr. Guo Qinghui reply Internal Medicine

Diabetic patients need to maintain their blood glucose levels within a certain range to delay the onset of complications.
The use of insulin or oral antidiabetic medications to control blood sugar each has its advantages, disadvantages, and limitations, and is also related to the patient's overall health status, such as heart, liver, and kidney function.
Your question should be discussed between your mother and her attending physician before making a decision.

Reply Date: 2006/02/21

More Info

When it comes to managing diabetes, the decision to rely on insulin or oral medications is a nuanced one that depends on various factors, including the type of diabetes, the patient's overall health, lifestyle, and how well blood sugar levels are controlled.
In your mother's case, it sounds like she has been managing her diabetes for over ten years and has recently transitioned to insulin therapy. Insulin is often prescribed when oral medications are insufficient to control blood sugar levels, particularly in type 2 diabetes. However, it is also common for patients to experience fluctuations in their blood sugar levels, which can lead to adjustments in their treatment plan.

1. Understanding Blood Sugar Levels: The blood sugar levels you mentioned (pre-meal 118 mg/dL and post-meal 148 mg/dL) are generally within acceptable ranges for many individuals with diabetes. However, the subsequent readings of 196/198 mg/dL indicate a significant spike, which could be concerning. It's essential to monitor these levels consistently to determine patterns and triggers for high blood sugar.

2. Insulin vs. Oral Medications: Insulin is a powerful tool for managing diabetes, especially when blood sugar levels are not adequately controlled with oral medications. It works by directly lowering blood glucose levels and is often necessary for individuals with type 1 diabetes or advanced type 2 diabetes. On the other hand, oral medications, such as Metformin or Sulfonylureas, can be effective for many patients, particularly in the early stages of type 2 diabetes.
3. Consulting with Healthcare Providers: Given the fluctuations in your mother's blood sugar levels, it is crucial to consult her healthcare provider. They can assess whether her current treatment plan is adequate or if adjustments are necessary. If her blood sugar levels remain high, the doctor may recommend resuming insulin therapy or adjusting the dosage.
4. Dosage Considerations: If insulin is deemed necessary, the dosage will depend on several factors, including her current blood sugar levels, her weight, and her overall health. The healthcare provider will typically start with a conservative dose and adjust it based on her response. It's important to follow the doctor's guidance closely and not to self-adjust the dosage without professional advice.

5. Lifestyle Factors: In addition to medication, lifestyle factors play a significant role in diabetes management. A balanced diet, regular physical activity, and weight management can significantly impact blood sugar levels. Encourage your mother to maintain a healthy diet that is low in refined sugars and carbohydrates, engage in regular exercise, and monitor her blood sugar levels consistently.

6. Regular Monitoring: Continuous monitoring of blood glucose levels is essential for making informed decisions about diabetes management. Keeping a log of her blood sugar readings can help identify patterns and inform discussions with her healthcare provider.

In conclusion, whether your mother should continue with insulin or switch to oral medications should be determined in consultation with her healthcare provider. They will take into account her recent blood sugar readings, overall health, and any other medications she may be taking. The goal is to achieve optimal blood sugar control while minimizing the risk of complications associated with diabetes. Regular follow-ups and open communication with her healthcare team are vital for effective diabetes management.

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