Comment Re:Rate of change (Score 1) 101
Ah, I had presumed Type 1, which is my specialty. Your MD is probably correct in holding off on insulin for now, but she may well progress to Type 1 and need it eventually. See http://www.diabetesnet.com/diabetes_types/diabetes _type_15.php for a description of Type 1.5. This is a good site in general, run by a Type 1 friend who is also a diabetes educator. His book, Using Insulin, is a very good one for Type 1 patients.
I'd be interested to know what kind of med she is on. Without insulin, the only thing that would likely cause rapid hypo would be too much insulin stimulation, which reducing the dose should mediate, depending on what it is.
There is an extreme approach you can find at http://www.diabetes-solution.net/ that it sounds like she is, in effect, using now. For a Type 1.5, Bernstein's "minimize the challenge" approach makes some sense, though I think his reluctance to use Huma/Novo-log with Type 1 patients needless.
A case could be made, once an appropriate basal dose of insulin stimulating meds has been determined, to control glucose highs with Huma/Novo-log, after determining the appropriate insulin/carbo ratio (probably less than the 1 U/10 g I mentioned for type 1 patients). The advantage would be tailoring the dose to the carb quantity, which you can't do as easily with something like glyburide or metformin because the dose acts too long. This would lead to the hypo events you describe.
Most endocrinologists who deal with Type 2 patients are reluctant to think of insulin, though, mostlly because they think patients dont't want to inject. The state-of-the-art is moving toward using insulin sooner as patients move from Type 2 to 1, though, and it is much easier to control glucose with insulin because it does the job and gets out of the way, when administered in a proper basal/bolus regimen.
I'd be interested to know what kind of med she is on. Without insulin, the only thing that would likely cause rapid hypo would be too much insulin stimulation, which reducing the dose should mediate, depending on what it is.
There is an extreme approach you can find at http://www.diabetes-solution.net/ that it sounds like she is, in effect, using now. For a Type 1.5, Bernstein's "minimize the challenge" approach makes some sense, though I think his reluctance to use Huma/Novo-log with Type 1 patients needless.
A case could be made, once an appropriate basal dose of insulin stimulating meds has been determined, to control glucose highs with Huma/Novo-log, after determining the appropriate insulin/carbo ratio (probably less than the 1 U/10 g I mentioned for type 1 patients). The advantage would be tailoring the dose to the carb quantity, which you can't do as easily with something like glyburide or metformin because the dose acts too long. This would lead to the hypo events you describe.
Most endocrinologists who deal with Type 2 patients are reluctant to think of insulin, though, mostlly because they think patients dont't want to inject. The state-of-the-art is moving toward using insulin sooner as patients move from Type 2 to 1, though, and it is much easier to control glucose with insulin because it does the job and gets out of the way, when administered in a proper basal/bolus regimen.
