Diabetes Forecast

Do I Need Insulin?

My blood glucose readings at bedtime are good, but in the mornings they’re high. I’m type 2 and have been on metformin for about 15 years. I am 78 and do a lot of walking and exercise. Is it time for me to go on insulin? Carlton Carpenter, Enosburg Falls, Vermont

Janis McWilliams, RN, MSN, CDE, BC-ADM, responds:

The decision about whether you should start insulin therapy is best made between you and your health care provider. However, let's review some information to take into account.

The American Diabetes Association recommends general goals of from 70 to 130 mg/dl for fasting glucose, no higher than 180 after meals, and an A1C of 7 percent or less (for most people). What is most important, though, is what your provider recommends for you. Your glucose goals can vary based on factors such as your age and medical history. Setting safe glucose ranges is an important part of your medical visit.

It's not unusual to have your highest glucose of the day in the morning. One possible explanation for high morning blood glucose levels is called the dawn effect (or phenomenon), thought to be caused by the early-morning rise in hormones that occurs in everyone. For more information, click here.

To help your provider determine the cause of your morning highs, check your glucose before you go to bed and once during the night, at about 3 a.m., over a few days to see if there is a pattern. Also, ask your provider whether you are still a good candidate for metformin. Because metformin is excreted by the kidneys and our kidney function decreases as we age, it is not always a good choice for someone up in years or for someone younger whose kidney function has declined.

Type 2 diabetes is a progressive disease, and its treatment may change over time. It's wonderful that you walk and exercise. This often helps lower glucose, not only right after the activity but even into the next day. It is possible that another oral medication may help or, as you suggest, a bedtime dose of basal insulin may be the best choice.

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