Insulin Resistance

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Nance Lovelace DO Posted: Fri, Sep 18 2009 10:05 AM

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I have a 44 yo male w/ T2DM [C-peptide high], whose glu remains in 300's.

Is on Levemir 70-units bid, Humalog 20-units w/ meals, is following a ADA diet, counting his CHO and walking a mile qd. Has seen an endocrinologist, he was not able to get glu below 300. Has been on Actos 45mg, Glucophage 1000mg bid along w/ above insulin.

I suspect he has severe resistance. I have just ordered him u-500 humulin R.  Any sugestions?

Nance Lovelace, DO

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Madman replied on Fri, Sep 18 2009 1:57 PM

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First off, I'm not a medical professional....just a diabetic.

Has this person tried a low carb diet to see if it helps? The ADA diet can still be pretty high in carbs.

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Ron AKA replied on Fri, Sep 18 2009 3:54 PM

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That is a lot of insulin and it would sure appear there is significant insulin resistance. I'm suspecting his BMI is high? I'm not normally a fan of a low carb diet, but you have to do something to get BG down from 300. Perhaps it is worth a try, and be sure the carbs eaten are of the low glycemic index type. The metformin could likely be increased to 2500 per day, but other than that maxed out on meds. Novolog insulin might give a bit more response than Humalog. But, it does look like more insulin is needed.

I think you need professional advice for a difficult situation like this. Perhaps trying a different endo would be in order.