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July 24, 2005

A1c (Glycohemoglobin, HgbA1c), Insulin

Question from Amsterdam, the Netherlands:

Last year, 2004, my A1c was around 8.1. In March 2005, it was 8.1 and is now 7.6. I have been on Glucovance and Actos for about a year now. My microalbumin is okay and I have no trace of retinopathy. Also, my cholesterol is excellent (I use Lipitor, too). According to my doctor, because of the above and my age, which is 73, I need not take insulin injections as long as my A1c stays around 7.5. I hope he is right! Who wants to inject himself daily? Is my doctor right? Of course I trust him, but a second opinion is very welcome!

Answer:

My recommendation to you is that you need to be cautious of free advice from someone who does not know you. There are no safe levels of high blood sugars. The American Diabetes Association Clinical Practice Recommendations suggest that the goal for therapy should result in A1c levels less than 7%. You are above this level, so, additional therapy should be recommended. You are already on three oral drugs (Glucovance is a trade name for a combination of two drugs). Therefore, insulin is not an unreasonable next step.

JTL