December 5, 2002
Complications
Question from Miami, Florida, USA:
I have suspected diabetes, my fasting glucose levels have been 115-130 mg/dl [6.4-7.2 mmol/L] with two-hour postprandial readings of 140-230 mg/dl [7.8-12.8 mmol/L]. (The high number are sometimes when I have a high carbohydrate diet). For the last three months, I have been exercising 45 minutes times a week, and avoiding foods with sugar and high carbohydrates, and my A1c was 5.9% last week.
My doctor does not believe I need an insulin sensitizer considering the A1c value. If the A1c is less than 6%, but glucose levels are relatively high, is the risk of complications still low? Should I pay more attention to the daily glucose levels?
Answer:
You have asked very good questions. Most of the work that has looked at complications from diabetes has looked at hemoglobin A1c as the major risk indicator. Normal hemoglobin A1c levels, if maintained over time, are still the best guarantee for avoiding complications. However, the course of the diabetes may change over time. Later on, your sugars may not be maintained by diet and exercise, and you may need medication. There is already information available that suggests that intervention of some type, whether it is intensive lifestyle change, metformin, or thiazolidinediones, have the ability to preserve function in the insulin-secreting cells.
JTL
