March 6, 2003
Daily Care
Question from Enfield, Connecticut, USA:
I have had type 2 diabetes for the last 15 years, and I also have high blood pressure along with protein in my urine. I am on glyburide twice per day, and I also take Accupril [an ACE inhibitor, Toprol XL, and Lipitor. I weigh 164 pounds and I am 5 feet 7 inches high. My A1c was 6.7% two weeks ago and has remained constant between 6.2 and 7.0% for the last year. I also exercise on a treadmill and use an exercise bike for 30 minutes per day.
I do my very best to control my blood sugar level, some times in the morning it is 60-100 mg/dl [3.3-5.6 mmol/L], but it is about 200-225 mg/dl [11.1-12.5 mmol/L] two hours after breakfast, lunch and dinner.The only way to keep it low is to eat half of what I normally eat which makes me hungry in two hours. I see the doctor once every three months, but he does not check my feet or explain clearly the results of the blood work (cholesterol, Hb1Ac, protein in urine etc. as to how good or bad it is, since the previous test).
I want to know who is responsible for treating diabetes aggressively. Is it the doctor or the patient? How do I go about reducing the blood sugar levels? Do I try all other oral medications before switching to insulin?
Answer:
You bring up several important questions that face patients and their medical providers when dealing with diabetes. I believe the ideal situation is a combination of an informed patient working hard to do the things they can at home and a physician who is interested and informed in the area of diabetes care. Part of the role of the physician is to communicate goals and treatment options so that patients can make the best choices possible. It is a joint venture.
If you are discouraged about your care, I would voice this with your physician. There may be additional issues you can both talk about and clear the air with. It sounds like you need an intensified regimen to treat your blood sugars. It is not appropriate to truly starve yourself in order to meet your blood sugar goals.
JTL
