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December 11, 2005

A1c (Glycohemoglobin, HgbA1c), Insulin

Question from Karachi, Pakistan:

I'm 43 years old and have had diabetes since April 1994. I take Glucomet plus (2+0+1) with Glucobay 50 (1+0+0) and one aspirin daily. On November 26, 2005, my A1c was 7.21. Due to a tight office schedule, I do not walk very much, eating a typical Pakistani diet. According to my glucometer, my fasting blood sugars range from 91 to 120 mg/dl [5.1 to 6.7 mmol/L]. My blood sugars range from 110 to 200 mg/dl [6.1 to 11.1 mmol/L]. How can I lower my A1c? Is insulin better than pills? Should I start taking insulin? What do you suggest?

Answer:

Your A1c is good, but could be better. In that spirit, it is appropriate to ask how it can be made better. For most of my patients with type 2 diabetes, I try to shoot for normal A1c values unless hindered by side effects, mainly hypoglycemia. You are taking two kinds of oral pills. You have to ask whether you are doing all you can do with your lifestyle. If you are not, you must direct your efforts there. For people who work in offices, this may mean exercising before or after work. It also means making sure your diet is everything it should be. If you have optimized the lifestyle end of your treatment, I would recommend discussing a strategy with your doctor. You can try a long-acting insulin with your orals, you can go to the optimum dose of your orals, or you could switch to insulin only. Any one of these could offer benefit. How much benefit you need goes back to how you are doing with your diet and exercise. If you need an improvement of over 1%, adding insulin to the regimen may be of help because it is most potent. However, if you can improve in other ways, it is not necessarily superior to insulin. Insulin is usually considered later in the treatment paradigm because it is considered to be invasive. If you can take the shots, it is a very efficient way of lowering your blood sugar. However, you will have to have it adjusted to prevent lows.

JTL