I was diagnosed with type 2 diabetes in October 2004. My A1c was 6.1. I have been controlling it with diet and exercise only. Last week, my A1C was 5.4. My doctor said I am controlling it very well. I also lost 20 pounds and am down to 139 pounds. Although I have it under control, my doctor is talking about medication and said we’ll talk about it at my visit with him in May. If I have this under control, I don’t understand why I may need to take medication. How do I know if medication is right for me? I really don’t want to take anything until it is necessary!

My cholesterol is slightly high. My total cholesterol went from 205 to 195 and my LDL went from 123 to 116, but it has come down.

At this point, you may not have to take anything for glucose control, but you need to consider medication for cholesterol lowering. Type 2 diabetes is very commonly associated with coronary heart disease and atherosclerosis. It has been recommended that LDL-cholesterol be lowered to less than 100 mg/dl as a minimum standard for all patients with type 2 diabetes. Some with significant vascular disease may even benefit to lowering it to less than 70 mg/dl. You should probably be on a baby aspirin each day.

Your albumin to creatinine ratio on your urine should be checked and this should be less than 30 mcg/mg creatinine. If not, or your blood pressure is elevated, you should be on an ACE inhibitor or an angiotensin II receptor blocker.

Type 2 diabetes is all about managing a cluster of cardiovascular risk factors over the course of your life. You don’t want to have to take extra medication, but you also do not want to lose the opportunity to be treated for these additional cardiovascular risks that co-exist with type 2 diabetes. I would also say that you should not accept anything less than a normal hemoglobin A1c. There is no safe level of hyperglycemia. To date, you sound like you have done a great job. Keep up the good work!

JTL