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July 27, 2002

Pills for Diabetes, Type 2

Question from LaPorte, Colorado, USA:

Recently, my mother-in-law's physician assistant took her off her chlorpropamide, saying that her A1c test was so good that she did not need it anymore. So far, her blood sugars have been 203 mg/dl [11.2 mmol/L] after eating, 233 mg/dl [12.9 mmol/L] fasting overnight, and another time 185 mg/dl [10.2 mmol/L] fasting for four hours. It has not gone below 145 mg/dl [8.1mmol/L], and most of the time is at least 165 mg/dl [9.1 mmol/L]. We called the physician assistant who said that this is fine, and we should just keep monitoring, but I was told that it should range between 120-140 mg/dl [9.1 mmol/L] so I am very concerned. Does this seem right or should I get another opinion?

Answer:

Based on the blood sugar results that your mother-in-law is finding throughout the day, it appears that she needs some type of diabetes medication to help her maintain the tight control that she had previously. Treatment goals for diabetes management strive for blood sugars as near the normal range (Fasting: less than 110 mg/dl [6.1 mmol/L] ; Random: less than140 mg/dl [7.8 mmol/L]) as possible without risking hypoglycemia. There are situations particularly in the elderly, where we might set higher target goals, such as cognitive or functional impairment, co-morbid illness, etc.

There are a number of different classes of medications for type 2 diabetes to accomplish aggressive control. Should low blood sugar be one of the concerns that motivated this change, her healthcare team might consider use of an oral agent that does not increase this risk (such as [metformin], Actos [pioglitazone], or Avandia [rosiglitazone]).

Talk to your mother-in-law’s healthcare team about your concerns with their current goals and seek their explanation. You do have the right to a second opinion, whenever there is any concern about the medical advice that you and your family have received. Provided that low blood sugar is not an issue, a hemoglobin A1c in the normal range is indicative of good diabetes management. Your mother-in-law is lucky to have you as her healthcare advocate.

DMW