I am 34 years old, have type 2 diabetes managed with diet and exercise, and my last three A1c levels are in the 6.3-6.7% range with fasting blood sugars normally around 90-115 mg/dl [5-6.4 mmol/L], but my post meal sugars are in the 150-180 mg/dl [8.3-10 mmol/L] range with occasional peaks at 200 mg/dl [11.1 mmol/L]. Should I be worried about my peak levels? Should I start taking some kind of medication? Am I okay as long as I keep my A1c within 7% range? Please advise. If I have to take care of my peak levels, any suggestions on the type of medications that I should start will be greatly appreciated.

Your hemoglobin A1c results and the blood sugar levels that you are measuring indicate that your diabetes is currently in excellent control. That is certainly attributed to the work you have done thus far with diet and exercise. You are correct to acknowledge that your post meal blood sugars do typically remain above ideal, and although you do not need to “worry” about the values that you are seeing, no one will argue that lowering them would further improve your control. In fact, many endocrinologists would like to see A1cs below 6%, which is tighter than the current American Diabetes Association goal of less than 7%. With the goal of both prevention of complications and delaying the progression of type�2 diabetes, in most cases, it makes sense to strive for as near normal blood sugar control as possible.

You haven’t included specific information about your current carbohydrate intake, but if appropriate and if you so desire, you may accomplish this goal with further dietary modifications, specifically lowered carb intake at meals and snacks. A dietitian is a wonderful resource in this endeavor. Many of my patients with type 2 diabetes find the book “The Schwarzbein Principle” by endocrinologist Diana Schwarzbein, MD to be a great resource as well. You can learn more about Dr. Schwarzbein’s approach to type 2 diabetes and health maintenance at her website. In addition, optimizing your timing of exercise (for example, just prior to or immediately after your large meal of the day) may assist in reducing the post meal rise you are seeing.

As your overall diabetes management is well controlled, your physician is probably not considering medication for you at this time.

DMW