Question: I take glipizide for Type 2 diabetes. I recently went from 5 to 10 mg twice daily (before breakfast and dinner). That, along with fewer carbs, has helped to maintain normal glucose reading during the day, but my overnight readings are still in the 150-160 range. What to do?

Dr. Hibberd's Answer:

Many diabetics share the same dilemma you have noted. Nighttime elevated glucose readings are clearly a problem for most diabetics on oral medications. We like to correct these elevations by providing a low dose of insulin at night. This is very easy to add and will be far cheaper than juggling multiple oral regimens.

Also, we favor using other agents to improve your body's utilization of glucose. Ask your doctor if you are a candidate for metformin treatment. Sometimes adding it to glipizide will control glucoses as well as insulin. I would normally try adding metformin before adding insulin at night.

Remember that nasal insulin delivery (non-injectible) may be an option for some, though its marketing and use has somewhat been de-emphasized after local nasal issues interfered with its use in some patients.