Inspiration And Expert Advice: Expert Columns

3. CHANGES IN INSURANCE & PHYSICIAN

Q. I had to change my insurance plan and doctor recently. Prandin is not on the new formulary so my existing doctor doubled my Metformin dose to 1000 mg twice a day. My average blood sugars were running 90-110 and without the Prandin, they are in the 110-125 range fasting, and up to 140 during the day. Is this still OK? My A1C was consistently 5.2%, but I won’t see my new doctor for a month. I am concerned about this. Should I worry?

A. I think there is merit in your concern. Your overall glucose average has risen, yet, we might not have the complete picture. If the values you listed were all pre-meal, then we have half of the equation in correlating your results with your A1C. By also testing 2 hours after a meal, you get the other half of the equation, that is, how high the glucose is after meals. Can you have a conversation with your existing doctor about finding another drug that is on the formulary that acts in a similar way to Prandin? Or have you considered a small dose of quick acting insulin to cover mealtimes? Insulin gets a bad rap which is unfortunate; high sugars are the real problem. When was the last time you saw a certified diabetes educator (CDE)? CDE’s can shed light into other possible causes of rising glucose levels such as pain, infection, stress, and certain medications (i.e. Prednisone). You can also call your new physician and speak to the nurse or medical assistant to upgrade your appointment or to get on a waiting list to be seen sooner. With diabetes, you have a VIP status that can get you in the door sooner if you talk with the right person.

4. FROM THE LAND OF LEVEMIR

Q. Have you heard about the new Levemir insulin from NovoNordisk?

A. Levemir (insulin detemir) is a long-acting insulin taken once or twice daily for type 1 or type 2 diabetes. Approved by the U.S. Food and Drug Administration in June 2005, Levemir shows greater predictability than NPH insulin with lower nighttime hypoglycemia rate, and less weight gain than NPH. It also has a reduced variability in action times when compared to NPH and Lantus (insulin glargine). One study showed 70 percent of those treated with Levemir achieved an A1C of approximately 6.6 percent. In other studies, Levemir achieved a level of glycemic control similar to that provided by other basal insulins, as measured by A1C.

Medications can make the diabetes difference providing you are on the right type and right amount of drug. Work with your healthcare provider to find the best one(s).

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NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.