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When to start insulin?
Mar 23, 2009

Dear Dr. Henry,

For over a year now I have been diagnosed with too high blood sugar levels. My doctor put me on Glimepiride, a drug that lowers the glucose. Because my blood counts are getting worse ( I peak at around 17.5) my doctor advised me to begin insulin injections. Obviously this is a fairly heavy burden, especially since my doctor tells me I have to inject 4 times a day i.e.: one in the morning (long duration) and then one before every meal. My question is: couldn't I just try to start this treatment with for instance one injection a day and then see if it is sufficient to keep my blood sugars under control? You understand that one injection a day is much easier to cope with. I do realise that the day will come that I will have to inject 4 times a day, but the longer I can postpone that, the better it is for me. What is your advice on the subject? Further I would like to know if my diabetes would again disappear if the underlying cause (the taking of protease inhibitors) is taken away? Or has the damage been done indefinitely to the pancreas? Thank you very much for your reply as always

Kind greetings

Robert from Holland

Response from Dr. Henry

Diabetes is very common in the general population and often with a strong genetic component. When to start insulin depended on severity of blood sugar problem and whether levels can be decreased to safe range with diet and oral agents. That assessment often needs input of diabetic specialist. In some cases glucose intolerance may be decreased if switched off an offending drug. Most of the newer protease inhibitors have had little or only modest effect on glucose/insulin levels (versus older protease inhibitors like indinavir) so usually the diabetes state will not be greatly impacted by switching off one of the newer PIs (though there may be occasional exceptions). KH

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