Type II Diabetic – Peak Insulin Levels

I am a Type II diabetic and have lost fifty pounds by exercise and diet. I no longer take insulin. I am now taking four milligrams of Amaryl per day. My blood sugar sometimes peaks at approximately 160 after 24 hours. Is this peak acceptable? I am a 64-year-old male.

I have selected this letter for one of this week’s postings because it describes how someone with Type II diabetes can really control their disease with diet and exercise, which should be the cornerstone of care for all Type II diabetics.

In Type II diabetes, the diabetic’s pancreas still produces insulin; in fact it sometimes produces more than usual. But despite this, the person’s blood sugars go too high and are not adequately controlled. This combination of insulin production but inadequate blood sugar control is known as insulin resistance. In contrast, someone with Type I diabetes stops making insulin, often completely. They must have insulin replaced by injection in order to control their blood sugar.

The cause of insulin resistance is not well understood, nor is it known why some people with insulin resistance do not become diabetic. People who are obese, and women with polycystic ovarian syndrome, almost all have insulin resistance, but not all of them become diabetic. There are undoubtedly some inherited factors that contribute to the insulin resistance and make someone more likely to develop frank diabetes. There are some populations, notably the Pima Indians of Arizona, in which almost 50 percent of the population is obese and develops Type II diabetes.

Although not all obese people develop diabetes, about 90 percent of all the people with Type II diabetes are obese. The substantial increase in the average weight of Americans over the past several generations is thought to play a major role in the increased numbers of people with Type II diabetes.

So if insulin resistance is so important in the development of Type II diabetes, what can someone with the disease do to improve their control? Since obesity is one of the causes of insulin resistance, controlling it is of major importance in improving the control of the disease. Exercise causes the muscles to increase their uptake of glucose, and therefore reduces insulin resistance. I have had patients who lost weight and exercised and were able to stop all diabetic medications, and had normal blood sugar levels. The writer of today’s letter has lost fifty pounds, a major accomplishment, and has been exercising. He has therefore been able to stop using insulin, and is taking only a modest dose of an oral medication.

Although he is concerned about his occasional blood sugars of 160, he has clearly achieved a great deal in taking control of his disease. I would be more interested in watching his Hemoglobin A1c test results, done perhaps every three months, than I would be worried about an occasional blood sugar of 160. If the A1c results, which measure the sugar control over a period of months, are normal, then the blood sugar of 160 is not worrisome, and he will probably be able to avoid the serious complications of the disease.

Unfortunately, doctors often become discouraged about pushing diet and exercise for their Type II patients, since motivating people to lose the weight and exercise regularly is often unsuccessful. It is easier to simply prescribe some pills, and eventually go to insulin treatment, than it is to be constantly pushing for diet and exercise. Nonetheless, anyone who has Type II diabetes should be aware that losing weight and exercising are the keys to successfully controlling the disease. A Type II diabetic must see a nutritionist regularly, must learn what foods contain carbohydrates (starches and sugars), protein and fat, and how to estimate the calories in the food they eat. Regular exercise, and by that I mean real huffing and puffing exercise like aerobics or jogging on a daily basis, has to become a regular part of the diabetic’s life.

We used to say in medical school that if everyone had to plant and harvest or gather their own crops, and personally run down and kill the animals they eat, we would have very little obesity and Type II diabetes. These are diseases of our modern, overfed and leisurely lifestyle. It’s a wonderful, enjoyable lifestyle, but not a very healthy one, and for anyone who is obese, particularly if there is a family history of Type II diabetes, it is a lifestyle that has to be changed.

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