December 7, 2014

Goals for a Person with Type 2 Diabetes

Our December 6 meeting was somewhat different than most meetings. We welcomed two additional members bringing our total to 33 members. The topic of goals was our discussion for the meeting and Max and I were the leaders.

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 our support group, we all have different goals and most seem satisfied with their goals. Do we always achieve our goals? Not even 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 61. However, this does not establish goals for anyone.

The first thing I want to emphasize is that there are no standard answers or rules. I did remind everyone of the rules in this blog. 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 how we set our goals. With the current number of thirty-three members and twenty-one 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 was the youngster in our group and we did 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 suggesting that we should check the A1c values monthly. For more information on this, please read this blog by David Mendosa. We used David's blog for discussion about this.

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 twenty-one members on insulin, our A1cs range from 5.2% 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. Those on oral meds had a greater variance and are still learning to manage their diabetes after learning more on management.

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. 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 70 mg/dl in the ten years on insulin and the next person has had only five readings below 70. Then the numbers go to three and two. Several of the group tries 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. Thirteen 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 close to 2015 and have now added sixteen additional members that are very happy to have us helping them. Brenda and Sue are probably the most pleased, as six of them are women and are happy to have others to talk with. Of the eight, four are on insulin and three are on oral medications, with Sue on no medications. 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.” Many questions were answered about multiple daily injections and testing. They 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.

The meeting ended and there was some intense discussion.

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