What to do? First, as pointed out above, it's up to your physician to sort through all the other possibilities that might be causing the glucose levels to rise and causing you to have diabetes symptoms.
If there are no other reasons, it's time to shift gears on your diabetes program: If you have been taking one diabetes pill, and it's not at the maximal recommended dose, the dose should be increased. If it's at the highest dose, it's time to add a second medication; adding a second medication almost always helps more than switching from one medication to another. The second medication might be another oral agent, or might be the injectible medication, Byetta.
If you are already on two diabetes medications, and having hyperglycemia and symptoms, there are several choices: add insulin to the two, switch from your present program to insulin, or add a third medication. There clearly will be reasons to choose one or another of these options, and frequently it's best to get an evaluation from an experienced diabetes team at this stage.
Maybe it's time to start insulin. In the past, some doctors took the approach that if the patient needed insulin, they should have all their previous diabetes medications discontinued. But that approach has fallen out of favor, and most physicians now add a single shot of long-acting insulin daily. Whether it's Lantus, Levemir, or NPH, adding a single shot to the medications the patient previously was taking often does the trick. Later, as the diabetes progresses further, doses may need to be increased, or two daily injections of long-acting insulin may be needed, and at some point, additional meal-time insulin may prove helpful.
A recent consensus statement issued by the American Diabetes Association and the European Association for the Study of Diabetes recommends adding basal insulin to a patient's medications if the A1C remains >7.0% despite lifestyle changes and administration of metformin. Thus, it is quite acceptable to use basal insulin as second-line therapy after metformin, rather than continuing to fiddle around with more diabetes pills and Byetta.
There are some very good practical reasons to start insulin at this time. First of all, it's easy to adjust doses. Second, it's relatively cheap compared to some of the newer name-brand pills that aren't available as generics. Third, there are only two side effects to watch for, although admittedly they can be big problems for some patients: hypoglycemia and weight gain.
So, if your diabetes is acting up, and you're feeling down, it's time for reevaluation. If no easily correctable problem is found, it's time to add more medication. And the additional medication might be another pill, or injections of Byetta or insulin. Sure, it's more work, but you'll feel better, and keeping your blood glucose under control will decrease the risk of future complications.
