February 14, 2013

Goals for a Person with Type 2 Diabetes

What are reasonable goals for a person with type 2 diabetes? This is a topic that has bothered me for the last few months. In out informal peer-to-peer group, we all have different goals and most seem satisfied with their goals. Do we always achieve our goals? Not even close to all of us achieve our goals every time we see our doctor, but for the most part, as a group we don't miss by a lot. While the average age varies every time we add to the group, the majority are now over the age of 65. However, this does not establish goals for anyone.

The first thing I want to emphasize is that there are no standard answers or rules. We all strive to maintain certain limits that we can live with or tolerate. We all agree to attempt to keep our A1c's under 6.5% and lower if possible. We have all stated that we need to keep our lipid levels in range, if possible, but we seldom discuss this part of our lives. We have also agreed that our goals are ours and not for anyone else to follow. It happens that several of us have very similar goals and we probably talk about this more than the rest. At present, none of us is limited cognitively and this is something we have agreed among ourselves to maintain a link to watch for any cognitive problems. Diabetes and cognition are two of the factors that have bound us more tightly as a group because we care about each other as individuals.

Even as individuals, it has been enlightening to how we set our goals. With the current number of ten members and nine of us being on insulin, there is quite a bit of similarity among us. Sue is still off all medications and she is happy that we support her with her goals. She wants to keep her A1c as close to 5.5% or under if possible. Even her husband is surprised at her success as her last A1c was 5.2%. She is the youngster in our group and we do tease her about this. She replies that if the old fogies would learn from her, we could be a lot healthier.

With the A1c range for people without diabetes (normal range) according the Joslin's Diabetes Deskbook being from 4.0% to 6.0%, we have to remember that prediabetes is defined from 5.7% to 6.4%. Prediabetes is another topic that many wish would be labeled as diabetes. Because A1c values do vary quarterly, some are advocating that we should check the A1c values monthly. For more information on this, please read this blog by David Mendosa.

With this in mind, here are some goals for people to look at as possible goals they should consider as their own. Therefore, select realistic goals and work toward them.  Of the nine members on insulin, our A1cs range from 5.5% to 6.5%. as of the latest A1c values. Some of us have the same A1c and don't get too concerned since this should be expected. Max and I are the only two that occasionally exceed 6.5% and then we have to work very diligently to make sure we get below 6.5% on the next A1c.

We are all careful to avoid hypoglycemia and three of the individuals have never had hypoglycemia. Since I have been on insulin the longest, by about two years, I have had the most incidents of this, but never one that I was not aware of or prepared to correct. On several occasions, I knew as soon as I put down the syringe that I was going to need to be aware of and prevent this from happening. On two occasions, I accidentally injected my short-term insulin in the same area as the long-term injection. I stayed up late both nights and fortunately had enough test strips and glucose tablets to stay out of trouble and only get to the lower 60's for blood glucose levels.

I have had eight readings below 65 mg/dl in the nine years on insulin and the next is only five readings below 65. Then the numbers go to three and two. Why do we choose 65 for our hypoglycemia? Because we can and in general we do not get below 70 mg/dl. Several of the group try to constantly remain under 125 mg/dl and above 80 mg/dl and have been very successful at it.

We are all fortunate to have the test strips we need or be able to afford more if insurance limits us. Five of us do obtain our diabetes supplies and medications from the veteran’s administration (VA) and are thankful for that. Our testing supplies are very much what we need and we make use of them.

We are now over a month into 2013 and have now added three additional members that are very happy to have us helping them. Brenda and Sue are probably the most pleased, as two of them are women and are happy to have others to talk with. All three are presently on oral medications, which is also revealing. In our first meeting, with three of the group absent for work, the ones new to the group were very curious as to why so many of us were on insulin. Brenda was happy to say “Greater ease of management.” This of course became our discussion for that meeting. The A1cs for the new members was 6.6% to 7.0% and they were surprised at our A1cs of all being 6.5% or less. Many questions were answered about multiple daily injections and testing. The three were surprised at our relaxed attitude about this and that fact that most of us did not think anything about the extra testing and multiple injections.

They were all surprised that we used our arms and different parts of our bodies for injecting insulin. They were very interested in why and Brenda was happy to answer that we needed to prevent insulin absorption and utilization problems and avoid creating scar tissue under our skin. This in turn would affect the insulin utilization and cause insulin waste if scar tissue caused the insulin not to disperse from the injection site. Some may escape, but not the full amount injected.

Then the question was asked about alternate site testing. We all stated that we used our fingers and not alternate sites because we wanted the “now” reading for accurate correction data and needed to know this. If we were going up or down was also mentioned. Then Tim said that for those on oral medications other than sulfonylureas, alternate site testing would work if their readings were fairly consistent. Brenda advised them to be careful if their readings were still fluctuating up and down since they were new to testing. Two were on metformin and one on a sulfonylurea and metformin. All three said their doctors had advised them against alternate site testing for now, but that they were happy that we were willing to talk about this.

Allen then said that they would all be wise to read about and understand insulin, but there was no hurry since so many of us were on insulin. Then he asked how long each had been on metformin. The answer was one year and the other two for only six and eight months. The two women asked if he was concerned about vitamin B12 and when Allen said yes and vitamin D, they said that the diabetes clinic had tested both of them for these and said both had been advised to add them as supplements. The fellow said he had also been tested. Then one of the women said they understood his concern after what had happened to him and he said then you have been reading Bob's blog. All three admitted they were and Allen said at least we are all on the same page.

Then we needed to call an end to the meeting and the three of them wanted to ask more questions. We allowed one question and they agreed. The fellow asked why I was the only one blogging. I could see the eyes looking at me, so I spoke up. I said most are not ready and they do not have the desire that I have. Ben then said, he agreed as he had thought about it, but even though he enjoyed the research, he was not ready to write even once a week. He said that he does send me blog ideas and I agreed and said several others do as well. Brenda said she has no desire, but enjoys most of what I write about, but not everything. She also said that they appreciated that I did not use their real names and had agreed that I could use a made up name to keep people identified.

Since people were anxious to leave, I told the three, that if they had any interest, to please contact me and I would tell them what I could. Two have and are especially looking for other resources and a few other bloggers to read. The one has been reading from the blogger list I maintain and I have sent both other bloggers from the type 1 bloggers and others.

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