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October 21, 2002

Tight Control

Question from South Carolina, USA:

I asked to take more insulin, and the doctor did not think it was needed. I adjust insulin for snacks and meals and take NPH before bed. I am eating a high protein diet and have changed my Hba1c from 10.8 to 4.7%. Why would doctors not try to bring people to normal A1c levels?

Answer:

I do not have a complete answer for your question. It may be that physicians do not always appreciate the importance of good glycemic control. Many physicians communicate to me that when they treat patients with type 1 diabetes, they are very hesitant about pushing the blood sugars down for fear of severe hypoglycemia. That is a real concern. However, our patients need to be instructed about this and how to avoid the serious reactions.

I am glad you now have a normal hemoglobin A1c studies have not shown marked improvement going below 6.0%, and hypoglycemia goes much higher so the risk/benefit analysis is not as convincing.

JTL