“Diabetes management?”

You likely have hyperinsulinemia which is typical in the setting of type 2 diabetes and insulin resistance. In your case you are also taking additional insulin. The liver is making (emergency fuel) glucose when you go relatively down overnight. Wearing a continuous glucose monitor such as freestyle Libre or Dexcom even for a brief period of time will help you pinpoint the issue. That is why you see a higher glucose in the AM than PM. Your care must involve measures to minimize the hyperinsulinemia. When it comes to insulin, the less, the better specially if the duration of diabetes is less than 10-15 years. Eating low fat , plant-based whole food is one way to lower your insulin requirement. I suggest you research in www.lifestylemedicine.org for more information on this. Also use this free website for cooking ideas. www.fullplateliving.org. I hope that helps.

Toujeo is used to control fasting glucose. If you are not taking this at night you should try this. You must decrease the carbohydrates, especially the grains. Increasing the Toujeo would lower the glucose in the morning but will cause more weight gain. If you have not taken metformin this would help.

Your sugar is still running high because you are insulin resistant and your medicines do nothing to help with insulin resistance. Giving extra insulin in your situation is like pouring fuel on the fire. (Since you are on glipizide I’m assuming you are a type 2.) You should ask your doctor if you could switch to GLP1 medications (Victoza, Ozempic, Trulicity) or SGLT2 medications (Invokana, Farxiga, Jardiance). If finances are an issue, then Metformin and Pioglitazone are powerful as well. Metformin is especially good at helping overnight sugars). Also you should have a sleep apnea test, because if you have sleep apnea, it increases cortisol overnight which contributes to insulin resistance, high sugars and Weight gain.

Dear patient ; if you are not eating high quantities of sugar after dinner you have severe insulin resistance and need more nighttime insulin and hypogoglcemic therapy. See your physician to discuss.

Respectfully
Marvin A Leder MD F ACP FACE

You need either a GLP1 or insulin actually probably both. Your body has run out of insulin. Things will not go well if you don't act soon. I have little information such as weight etc. Let us say you are very overweight, it is possible in some to eat very little or for that matter fast, then one can become insulin sensitive and the glucose will come down. Eating when the glucose is in the 300s makes little sense. I am worried about you and you need help.

This question has to be answered by your endocrinologist who knows you better and can suggest how to adjust your insulin.

You are not on enough long-acting insulin if you rise 100 points. That is your Toujeo. Speak to your doctor because even the 200 values are too high. At your age, you need to be 100-180 78% of the time TJ.