by Wesley W. Wilson, MD
Includes art: Medical Caduceus.
NOTE: If you have any questions for "Ask the Doctor," please send them to the VOICE editorial office. The only questions Dr. Wilson will be able to answer are the ones used in this column.
Wesley W. Wilson, MD, has retired as an Internal Medicine practitioner at the Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type 1 diabetes in 1956, during his second year of medical school. He remains interested and involved in diabetes education for patients and professionals.
Q: I've had type 2 diabetes for 31 years. Most of that time, I've been pretty overweight, and just recently, my doctor started me on Lantus insulin, and got me on a serious weight loss program. It's working -- I'm losing weight. Am I going to need less Lantus, or other medications, as I lose the weight? What is the relationship between amount of medication and degree of overweight for a type 2 person like me?
A: It's great that you've heard the call and have lost weight and, I suspect, improved your blood sugar levels. I'd encourage you to write an article giving your insights into how you were able, after 31 years, to come to grips with your overweight problem and achieve weight loss. I'll bet your program included at least some increased activity (exercise) since addition of insulin to a diabetes control program makes weight loss even harder. You are proof that with dedication, even difficult goals can be achieved.
Type 2 diabetes is at least, in part, caused by insulin resistance. This means that any given amount of insulin will have less blood sugar lowering effect than in a person without insulin resistance. We have two very powerful ways to reduce insulin resistance: Weight loss and exercise. Both act to make a person more sensitive to the effects of insulin. Weight loss and increased exercise both will reduce your need for added insulin. The problem is -- I can't tell you how much your need for insulin will change with a specific amount of weight loss or increase in exercise. Each person responds a bit differently to weight loss, exercise, or to insulin itself. I can be definite, however, that you will be increasingly sensitive to insulin as long as you continue weight loss and exercise.
Insulin is a powerful drug that can lower the blood sugar to below normal (hypoglycemia) and therefore must be monitored very carefully. I feel that persons who use injected insulin must check blood sugar levels more often than those not using insulin. Symptoms of low blood sugar include nervousness, shakiness, hunger, sweating, and irritability. If not detected and treated with some sugar, the symptoms may progress to confusion, or even convulsions or coma. This is another place where you must take control and check blood sugar if unusual symptoms occur, and then take some sugar if needed. After that, discuss the hypoglycemia with your doctor. I think it's very likely that your dose of Lantus will be reduced as you continue weight loss. I've seen some persons who were able to eliminate insulin injections with exercise and weight loss.