Poorly controlled diabetes: further management

Patient: I have been told I am insulin resistant which was originally noticed on some bloods done about two years ago. I have been prescribed Metformin. I take 1500mgs a day, 1 tablet in the morning and two at night. I recently had my bloods again and everything was normal except my insulin level which was up….41. I was told it should be under 10. Shouldn’t the Metformin I’m taking reduce my insulin levels (or make the uptake of insulin better)? If my levels are up while on Metformin does that mean that they would be even higher without it? What level is considered high, extremely high etc. Should I be majorly concerned about this level. I have very recently started seeing a dietician and have begun regular exercise and am determined to do everything in my power to change this, but want to understand what the levels mean. The nurse in the clinic couldn’t answer my question and my doctor has gone on holiday Thanks for your help. PS It was difficult to write this question because everytime I put my curser in the question box the drop down box appeared and wouldn’t go away., until I left the box.

Doctor: Diabetes is a condition in which the peripheral tissue is insulin resistant thus leading to an increase in glucose level s in the blood which can be dangerous potentially if not controlled.The criteria to diagnoses DM is as follows : Presence of diabetes symptoms + random plasma glucose of > 11.1 mmol/l OR fasting blood glucose of >7 mmol/l OR Oral glucose tolerance test 2 hour glucose level of >11.1 mmol/l.A level of 41 is high considering that you are on metformin already.In some individual only treament with metformin may not be effective and thus you may need to add another anti diabetic medication to your regime or may need to start on insulin. While the level of glucose in your case is not extremely and dangerously high right now having such chronically high levels makes you more prone to complications of diabetes including nerve issues, eye problems , high risk of cardiac problems etc. It is good that you have started regulating your diet and exercising as that has been proven to be beneficial.Thank you for the feedback on the system. All the best.