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April 25, 2005

A1c (Glycohemoglobin, HgbA1c), Type 2

Question from Connecticut, USA:

My 78 year old mother has had type 2 diabetes for 10 years. She is taking metformin 1,500 mg, Amaryl 4 mg, and Avandia 4 mg per day. Her last A1c for years was steady at 8.3%, then, with strict diet control (11 carbohydrate portions per day), was brought down to 7.5%. Now, six months later, it is back up to 8.6% despite strict diet control. Could her diabetes be worsening because of her age? Do any of these medications contribute over time to the pancreas ceasing to work? She will either have to be increase the Amaryl to 8 mg or the Avandia to 8 mg per day. In your opinion, which increase would be most beneficial?

Answer:

The use of more and more medications over time is a direct result of the natural course of the disease. This has been seen over and over again. Treatment should be directed at getting the A1c under 7%. If not, she may have to be treated with insulin. I would recommend increasing either one and follow the results. You will need to discuss this with her physician.

JTL