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July 13, 2001

Type 2

Question from Toronto, Ontario, Canada:

About two years ago, my 65 year old father-in-law was diagnosed with borderline type 2 (I believe) diabetes, and he was told this could be controlled with diet and exercise. We finally had him purchase a home monitor, and last night, we got a reading of 15mmol/L [270 mg/dl]. We don't know where to start with controlling this. Is there some sort of chart or table we can use to ensure proper levels? What's the next step?

Answer:

You have asked a good question, and I’m not sure where to begin. I guess I will start with your father-in-law’s diagnosis two years ago.”Borderline diabetes” is the same idea as being “borderline pregnant”. He has, and has had, diabetes. In the early stage of type�2 diabetes, it is true that blood sugars can often be maintained in target ranges ( less than 7 mmol/L [126 mg/dl] before meals and less than 10 mmol/L [180 mg/dl] after meals, according to your Canadian Diabetes Association guidelines) by modifying how much carbohydrate is eaten at each meal and adding exercise. For some people, this works extremely well, and for some it doesn’t make a difference. Each person’s journey with diabetes is unique. Some people can go along for years managing this way while others need to add medicines rather quickly to bring the blood sugars into the target range. As the pancreas’ ability to make insulin diminishes over time, it is expected that medicines will be necessary to achieve target blood sugars.

My suggestion for your father-in-law is to make an appointment with his physician right away. For a few days before the appointment, it would be helpful if he would gather some information for that visit. Have him begin a diary of blood sugars before each meal, write down what he eats and how much it is, and test the blood sugar one to two hours after eating. This will help him and his physician see where the problem with blood sugar management is. It is likely that he will need medicines added, and there are several types available to treat type 2 diabetes.

I hope your family also takes advantage of diabetes education programs available in Toronto. I have met several of the educators there and encourage you all to learn what’s possible in managing diabetes today. I hope your father-in-law will do all he can to achieve target blood sugars for the long haul. It is no longer necessary to give up a quality life to manage diabetes. It can be a packaged deal.

KS