FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

TIGHT CONTROL OF DIABETES PROVIDES LONG-LASTING BENEFITS

Question: My friend and I both have type II diabetes. When we compare notes on our care, we have found that her blood sugar is much higher than mine. It gets as high as 185 after meals. She says her doctor is afraid she will have hypoglycemia (low blood sugar). My doctor says I should try to keep my sugar as close to normal as possible. Whose doctor is right?

Answer: Management of any illness can vary from patient to patient and doctor to doctor, but several studies have shown that tight glucose control can delay or even prevent the complications of diabetes. People who keep their blood sugar in the same ranges as a person who is not diabetic will benefit in the short term and long term as well.

The immediate benefits of “normal” blood sugar levels are that you feel better and that you no longer have symptoms associated with high blood sugar, such as thirst, frequent urination, fatigue, hunger and blurred vision. The long-term complications of diabetes can have serious ramifications. They can cause irreversible illness and shorten your life. High blood sugar damages your kidneys, heart, blood vessels and nerves. Once that damage has occurred, it cannot be undone.

So what should your sugar be? Your fasting morning sugar should be less than 105 milligrams per deciliter. In a non-diabetic, normal non-fasting sugar is between 70 and 120 mg/dl. If you are a diabetic, your sugar should be between 90 and 130 before meals, less than 180 two hours after eating, and less than 160 at bedtime. Some sources are a little more stringent. They want 135 two hours after eating and 120 before bedtime. Even using the more lenient guideline, you can see that your sugar should never be over 180.

Also, your at-home blood sugar readings should correlate with the hemoglobin A1C at your doctor’s office. It, too, should be close to normal, which is less than 7.

There are many new medications on the market for the management of type II diabetes. There are pills and shots. You should ask your doctor how often you should check your sugar. If he or she is not recommending frequent checks, you may want to ask why. There are some patients for whom such tight control is not generally recommended. Older people, those with complications from diabetes or heart disease, children, and people who are prone to low blood sugar reactions may need a different level of control. But for most of us, tight control will provide long-lasting benefits.

Finally, you may find it beneficial to meet with a diabetes educator. They can answer your questions about diet and control, and they can work with your doctor to get optimal blood sugar control for you.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.