You have to pay attention to a lot of numbers when you have Type 2 diabetes.
One of the most important is your average blood-sugar level over a two- to three-month period.
>> About 5 percent of people with diabetes have Type 1 diabetes; the majority has Type 2.
That number — called the A1C — has been key for diabetics in measuring how well their treatment plan is working. And for years, the number has been a “one-size-fits-all” approach in some circles.
But new guidelines from the American Diabetes Association give diabetics and their health-care providers more leeway in setting a target number.
The recommendations allow them to take into account the patient's overall health, life expectancy, duration of the disease, propensity for developing low blood sugar and motivation for sticking to a strict program.
“We've known for a long time that the guidelines may be dangerous for an older person,” said Dr. Steven Zuber, an internal medicine physician with Methodist Physicians Clinic. “Or (that they're) not as aggressive as needed for a 20- or 30-year-old who has 60 or 70 years left to their life.”
The changes, Zuber said, acknowledge that “you can't treat everybody the same, because they're not.”
With Type 2 diabetes, your fat, liver and muscle cells don't respond correctly to insulin, a hormone that helps blood sugar get into your cells and stored for energy.
If sugar can't enter the cells, high levels build up in the blood. Left untreated, high blood-sugar levels can cause all sorts of complications with your eyes, kidneys, heart, nerves and feet.
Medicines and changes in diet and exercise can lower a person's blood-sugar levels.
One potential problem with getting everyone's A1C levels under the recommended figure — 7 percent — is the risk of dropping the blood-sugar levels too low.
“If they drive a car and get low blood sugar, that could cause an accident,” said Dr. Cyrus Desouza, an associate professor at the University of Nebraska Medical Center and chief of UNMC's Division of Diabetes, Endocrinology and Metabolism. “They could fall unconscious. If it happens repeatedly, your body loses the ability to warn you (when your levels drop). ... It can affect your memory.”
So for older people with severe health problems, allowing the A1C level to go up to 7.5 to 8 percent may be appropriate.
“If you've got a major inoperable cancer, you're not responding to chemotherapy and you've got heart failure, you're not worried about a 10-year risk” from high blood sugar, said Dr. Vivian Fonseca, the ADA's president of medicine and science.
But an otherwise healthy older person could aim for a lower A1C.
Bob Klesath of Papillion, 71, takes insulin and watches his food intake to control his diabetes. He said his A1C readings stay in the 6 percent range.
In the last 10 years, he said, his blood sugar has dropped too low about five times, mostly after he went too long without eating.
“It doesn't take me very long to know it's low,” Klesath said. “You get kind of disoriented a little bit. Not completely. You get a funny feeling. You know it's time.”
The ADA guidelines say healthy, motivated people with a long life expectancy and no significant cardiovascular disease should try to keep their A1C between 6 and 6.5 percent if they can avoid low blood-sugar levels or other adverse effects.
“We don't want patients to have a lot of low blood sugars,” said Julie Kamphaus, a certified diabetes educator with the Diabetes Education Center of the Midlands. “It gives them a lot of symptoms: shakiness, weakness, foggy thinking, foggy vision.”
It's all about keeping the blood-sugar level under control — not too high, not too low. Doing that takes a high level of motivation.
“The doctor's not going to baby-sit you,” said Desouza, adding that people must take their medications, check their blood sugar, eat right and get the right amount of exercise. “It's very difficult for some patients to actually do it. They would do it for a couple of months, get fed up and go back to what they were doing.”
Yehuda Handelsman, president of the American Association of Clinical Endocrinologists, said his group, which aims to get the majority of diabetics below a 6.5 percent A1C, has recommended a personalized approach to managing high blood sugar since 2009.
Except for the recommendation of metformin as the best first choice of an antidiabetic drug — because not everybody can start on it — he said he is happy with the ADA's guidelines.
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