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Diabetes

Why Janumet and Glimepride Aren't Working?

09/28/2010

Question:

I am presently taking Janumet 50/1000 twice a day and glimepride 2 mg twice a day, but my sugar is still staying in the 200+ range. I don`t want to take insulin. I weigh 152 pounds, and I am 52 years of age, female. I walk at least 30 minutes a day - up to 2 miles, and also work out at a gym on weight training and yoga. I don`t understand why my sugar is still so high. It was 272 this morning.

I work in the medical field as a medical transcriptionist and know what I should and should not do.

Any suggestions?

Answer:

First of all, kudos to you for exercising regularly and staying on top of your blood glucose tests! If you don't test, you can't evaluate your treatment. You obviously know it is important to test your blood glucose regularly, and you look for answers when your tests are consistently out of the desired range.

You are right to be concerned about a blood glucose test of 272, and many tests over 200. The medications that you are taking are among the medications recommended for the treatment of type 2 diabetes. Your diabetes care provider knows your whole health history, it is important that you talk to him or her about your concerns. You may need a change in therapy if your numbers continue to be high.

I am assuming you have type 2 diabetes. People with type 2 diabetes have high blood glucose levels for a number of reasons. An impaired ability to use insulin (insulin resistance), and the liver's release of glucose when it isn't necessary, result in an increased demand for insulin. A defect in the way the cells work that produce insulin results in ineffective insulin production. If your body can't produce enough insulin to counteract the other problems, blood glucose levels will be high. The medications you are taking are trying to correct these problems. But the high blood glucose tests you are seeing tell us that something needs to change.

It sounds like you are dreading the thought of taking insulin, should it become necessary. Try to keep good blood glucose levels as your top priority, not avoiding insulin. No one is thrilled to take injections, but today's insulin pens and pen needles are easy to use and cause only minor discomfort. If you are taught to use insulin by a diabetes educator, you will find it is not as hard as many people think it will be. When blood glucose levels are very high for a while, insulin can be very effective in getting glucose levels back to normal. When glucose levels are closer to the normal range, other diabetes medications can work better to keep them there.

Talk to your diabetes care provider about your blood glucose results, and talk over the options for improving them. Keep exercising and maintain a normal weight. Don't be discouraged if blood glucose levels are high even though you are working hard at controlling them. And if some day taking insulin is necessary, remember to keep your eyes on the goal - good blood glucose levels, and a low risk of diabetes complications, are worth it!

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Response by:

Nancy J Morwessel, CNP, MSN, CDE Nancy J Morwessel, CNP, MSN, CDE
Pediatric Nurse Practitioner
Diabetes Center
College of Medicine
University of Cincinnati