September 3, 2014
What Is Unmanaged Diabetes?
When reading this blog, some very definite thoughts came to mind. I do like the topic,
but I become nervous with the wording. I would like to be a little more definitive and clear a couple of points.
The American Diabetes Association (ADA) does use the HbA1c measurement of 7.0% for their guidelines. At least the American Association of Clinical Endocrinologists (AACE) uses the guideline of 6.5%. For those that are very capable of managing type 2 diabetes, many like to keep their A1c's in the 5% range. Others feel great if they can maintain A1c's in the 6% range.
Because doctors and endocrinologists are so fearful of patients having episodes of hypoglycemia, or low blood glucose they become very cautious of anything below the guidelines. Then, when we consider people aging, again they become even more cautious about peoples' A1c. At age 65, they start encouraging A1c's of 7.0 to 7.5%. Then at the age of 70, they want the range to increase to 8.0%.
This is where I disagree with their one-size-fits-all philosophy. I could agree if they were properly assessing us and individualizing our treatment. Some people are able to manage diabetes and maintain lower A1c's. Some lose diabetes management abilities as they age and this must be properly assessed and adjusted to maintain quality of life. Hopefully as they become less capable of managing their own diabetes, there will family or other caregivers available. They will lose quality of life when incarcerated in nursing homes or care facilities.
So what is unmanaged diabetes? Following the above discussion, there are many variables depending age and patient capability. My suggestions would be that for people on oral medications and below the age of 65, then unless they are on medications or a combination of medications that can cause hypoglycemia, the daily blood glucose readings should be used to see how often they get below 70 mg/dl. If they consistently show readings below 60 mg/dl then they need to be assessed to see if they are capable of managing their own diabetes.
This assessment needs to be continued as patients continue to age. Even more careful assessments will be needed if the patient is on insulin. Warning: Insulin should never be the medication of last resort. This is the habit of too many doctors and can lead to complications setting in before insulin is used.