Q1. My blood sugar remains high (135 or higher) for 12 to 15 hours after I eat. My general practitioner says I have diabetes, but my ob-gyn has diagnosed me with insulin resistance. What is the difference and should these conditions be treated differently? How is it possible that two doctors think I have two different conditions?
— Patricia, Florida
Insulin resistance is usually found in people who are overweight. The metabolic changes that are brought on by excess weight prevent cells in the liver and muscles from utilizing glucose, despite normal insulin levels in the body. Insulin is the hormone that helps our body metabolize, or burn, glucose. The body in effect becomes "resistant" to insulin. The body's response to this is to produce more insulin. Unlike some diabetics, whose bodies produce insufficient amount of insulin, individuals who have insulin resistance have high levels of insulin early on in the disease. This process is rather complex and genetic susceptibility to diabetes plays a big role, but suffice it to say that long-term insulin resistance eventually leads to diabetes.
The goal of treatment is to normalize day-to-day sugar levels. If you are carrying excess weight and your pancreas still produces an adequate amount of insulin, most likely you have some degree of insulin resistance. You will benefit, therefore, from medicines that are considered insulin "sensitizers." These include medications that fall under the classes of drugs known as metformin (Glucophage) and thiazolinediones (two drugs in this class are pioglitazone — Actos — and rosiglitazone — Avandia). They help your liver and muscle cells better utilize glucose. It is possible, however, that additional medicines will be required to manage your diabetes. In this case, medicines that increase insulin production from the pancreas will be considered. These are called insulin secretagogues and include glyburide, glipizide, and glimepiride. If your pancreas is not producing insulin at all, then injecting insulin becomes absolutely necessary.
Q2. My husband was diagnosed as "prediabetic" following a heart attack two months ago. I did some research into that term and learned about "insulin resistance." The symptoms listed for both diseases led me to believe my husband was not prediabetic but rather fell into the category of insulin resistant. Can you tell me more about it, and how to treat each of these conditions?
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Prediabetes is the condition the 1 last update 02 Jul 2020 of having abnormal levels of glucose, or sugar molecules, in the blood; insulin resistance refers to the mechanism by which one develops that condition. They're not two different conditions; they're cause and effect — insulin resistance is a prediabetes state.Prediabetes is the condition of having abnormal levels of glucose, or sugar molecules, in the blood; insulin resistance refers to the mechanism by which one develops that condition. They're not two different conditions; they're cause and effect — insulin resistance is a prediabetes state.
The human body uses sugar as a fuel (energy) to live, function, and produce. To this end, sugar has to be transported from the for 1 last update 02 Jul 2020 bloodstream across cell walls into the cells, where the sugar is actually burned and turned into energy. Insulin is a key hormone produced by the pancreas, primarily as a response to the sugar absorbed into the bloodstream after you eat a meal. Insulin acts on cell walls in such a way that the cells can take up and metabolize sugar. If the cell walls don't allow insulin to do its job, a person is said to have insulin resistance.The human body uses sugar as a fuel (energy) to live, function, and produce. To this end, sugar has to be transported from the bloodstream across cell walls into the cells, where the sugar is actually burned and turned into energy. Insulin is a key hormone produced by the pancreas, primarily as a response to the sugar absorbed into the bloodstream after you eat a meal. Insulin acts on cell walls in such a way that the cells can take up and metabolize sugar. If the cell walls don't allow insulin to do its job, a person is said to have insulin resistance.
Most adults who develop prediabetes have insulin resistance. (A smaller proportion of individuals who have prediabetes have insulin deficiency.) If cells such as those of the liver and muscles are resistant to insulin, then sugar cannot enter cells easily and remains in the bloodstream at levels exceeding normal values — that's prediabetes (or diabetes). Prediabetes is diagnosed when the level of glucose is abnormal but below diabetic values: fasting values of 100 to 125 milligrams per deciliter, and 140 to 199 mg/dl two hours after a glucose load. For diabetes, the cutoff values are 126 mg/dl (fasting) and 200 mg/dl (two hours after a glucose load).
To make things worse, lipid (cholesterol) metabolism is also affected by insulin resistance. To overcome resistance, the pancreas produces more and for 1 last update 02 Jul 2020 more insulin — and unfortunately, increased levels of insulin are detrimental to our arteries and are associated with high blood pressure.To make things worse, lipid (cholesterol) metabolism is also affected by insulin resistance. To overcome resistance, the pancreas produces more and more insulin — and unfortunately, increased levels of insulin are detrimental to our arteries and are associated with high blood pressure.
reducing blood sugar quickly charts (☑ expected findings) | reducing blood sugar quickly treatment nhshow to reducing blood sugar quickly for The goal of treatment for prediabetes is to prevent or mitigate both the onset of diabetes and the cardiovascular (heart and blood vessel) complications that come with it. A research study showed that individuals with prediabetes who engaged in physical activity, consumed a healthy diet, and lost at least 7 percent of their body weight reduced their risk of developing diabetes by 58 percent. The same study showed that taking a diabetes medicine (metformin) reduced the risk by 31 percent.
Ask your husband's doctor for a more tailored approach for your husband — and stay tuned.
Q3. I take Glucophage for diabetes. Is there a "magic number" at which I am likely to have to start taking insulin instead?
— Anna, Florida
You're right in thinking that at some point in the future, Glucophage alone might not be sufficient to treat your diabetes. For most adults who have diabetes, adding a second oral medicine works to provide good glucose control. The point at which you might require insulin would be when those oral medicines no longer lower glucose levels to acceptable levels. This is the stage when the pancreas loses the capacity to produce an adequate amount of insulin. At this stage, oral medicines are no longer effective at normalizing your glucose levels.
Since various factors influence the production of insulin in the pancreas, it's not easy to determine when this will occur. For instance, having diabetes for a long period of time and having persistently high levels of glucose lead to a decline in insulin production. Obesity, lifestyle factors, and other diseases also accelerate the rate of progression to the stage at which insulin might be required.
The most convenient and reliable method to determine glucose control is to measure the hemoglobin A1c percent in the laboratory. Excess glucose attaches itself to proteins in our bloodstream, and hemoglobin is one such protein. The higher the percent of hemoglobin A1c, the poorer the glucose control. The goal is to get this number close to 6 percent. If your number is consistently much higher than 6 percent, it is time to increase the dosage of the medicine you are currently taking or add a new medicine. A hemoglobin A1c level above 7 percent means that your average fasting blood glucose level is at least 150 mg/dl.
Having said this, insulin for 1 last update 02 Jul 2020 might be the best treatment for many individuals who are on more than two medicines for diabetes control. Insulin is highly effective and has fewer side effects than many oral medicines.Having said this, insulin might be the best treatment for many individuals who are on more than two medicines for diabetes control. Insulin is highly effective and has fewer side effects than many oral medicines.
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— Elizabeth, Texas
Taking insulin to compensate for the occasional dietary intake of sweets is not harmful in itself. If, however, you're injecting insulin without counting your carbohydrates or considering proper injection techniques or the overall severity of your disease, it is dangerous. Too much insulin can lead to severe hypoglycemia. Additionally — and in general — taking medicines prescribed for others is not recommended.
While sweets are not inherently bad, they count in your overall carbohydrate intake, and you should substitute them gram for gram for other carbohydrates that you eat on a particular day. It's also important to consider the cholesterol and other fats contained in most sweets. As you know, cholesterol-rich and high-fat foods, including cakes, cookies, and ice cream, contribute to elevated cholesterol and triglyceride levels in your blood, which are detrimental to your cardiovascular health.
I suggest that you monitor your sugar levels, document the pattern of your intake of sweets (that is, the quantity and type of sweets you eat, and how often you eat them), and consult your doctor about the best way to manage any potential rise of glucose. If you're not currently on insulin, you might be able to take short-acting oral medicines prior to a meal. This might be sufficient to compensate for the potential rise in sugar after you eat sweets. If your hemoglobin A1C is not at the desired level, your doctor may consider prescribing regular doses of premeal hypoglycemic medicines, or one of a new class of medications called incretin mimetics, which work by stimulating the pancreas to secrete insulin when blood sugar levels are high. Medications in this class include exenatide (Byetta) and sitagliptin (Januvia).
Learn more in the Everyday Health Type 2 Diabetes Center.