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November 29, 2001

Daily Care, Type 2

Question from San Diego, California, USA:

I am 39, was diagnosed with type 2 diabetes about six months ago, and I am treated with diet and exercise. Can you explain the progression that takes place for a person with type 2 diabetes who is diet controlled to one who needs medications? What is the doctor looking at the fasting levels, the A1C, and the highest daily elevations? There seems to be a variety of opinions out there on when someone should take oral medications. Is there a consensus paper written anywhere that has any criteria that I could read?


Type�2 diabetes is like a story line. It has a plot of its own. Just because you have blood sugars which are controlled on no medications doesn’t mean they will always be controlled that way. Over time, insulin secretion may fail and necessitate further therapy. Approximately 40% of patients with type 2 diabetes end up on insulin. Progression is indicated by a rise in hemoglobin A1c over time, as well as a trend upward on your sugars monitored at home.


[Editor’s comment: See Type 2 Diabetes on the American Diabetes Association website.