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January 13, 2002

Daily Care

Question from Sydney, New South Wales, Australia:

I have had diabetes treated with pills for eight years, and although I have kept my sugar levels in control for most of the time, I also neglected them such that my A1c was 10% for while. Now, the ophthalmologist says that the blood vessels in my eyes have been affected slightly (but reversibly), and I am very concerned because I get an uneasy feeling that the sugar problem has started taking its toll. I have decided to do all that it would take so as not to let the sugar level go above the upper limit. Could you please let me if my diet is okay? More importantly, what should blood sugar levels be at different times of the day as per the American standard? My daily diet is as follows: 6:30 am breakfast -- two slices of toast (no butter), one cup soy milk and a boiled egg. (I take one tablet 20 minutes before breakfast). 12 noon lunch -- three to four slices of toast (no butter), a few pieces of cottage cheese, and one cup yogurt. 8:30 pm dinner -- Salad, boiled vegetables, rice and pulse. (I take the second tablet 20 minutes before dinner.) I walk about 5 kilometers (four miles) in 45 minutes almost every day. With this diet and exercise my fasting blood sugar reads 6.5-7.2 mmol/L [118-140 mg/dl].

Answer:

There appears to be nothing wrong with your diet. If your sugars are rising and the medication is not satisfactory at keeping your hemoglobin A1c at an optimal level, additional medication can be added. This is not uncommon.

For day to day management, I would prefer to have my patients have blood sugars less than 140 mg/dl before meals and bedtime. Once they reach these goals, it is best to use the hemoglobin A1c to guide any additional lowering. The American Diabetes Association has recommended that the hemoglobin A1c be less than 1% above the normal range for your lab. Therefore, if your lab has a normal value up to 6%, you should aim for a value less than 7%.

JTL
Additional comments from Lois Schmidt Finney, diabetes dietitian:

Eating a variety of fruits and vegetables is a very important component of the meal plan for people with diabetes, and it looks as though you are a bit low in these. I think your best bet would be to see if you can locate a diabetes team and discuss all aspects of your diabetes care with them. is — your health care team needs to give you that information. It sounds as though you are very interested in attaining the best possible care and best possible health, so you are making the correct first step in finding as much information as possible.

LSF

[Editor’s comment: See the ADA’s Clinical Practice Recommendations.

SS]