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Updated December 28, 2006

Questions For Your Doctor
Ensuring Good Care

by Jan Chait

The American Association of Clinical Endocrinologists (AACE) recommends a fasting blood glucose level of below 110 mg/dl, a level of less than 140 mg/dl two hours after you’ve taken the first bite of a meal, and an HbA1c of less than 6.5%. Individual blood glucose readings show what your level is at the time you check, while an HbA1c test shows your average blood glucose levels over a period of about three months.

While these numbers are the goals advised for most people, your doctor’s recommendations may vary depending on a number of variables, including pregnancy, age, and other health considerations. For example, Dr. Helena Rodbard, chair of the AACE’s Diabetes Care Guidelines Revision Task Force committee and an endocrinologist practicing in Rockville, Maryland, says, “In a patient with hypoglycemia unawareness (a condition in which blood glucose levels fall very low without triggering any of the usual warning symptoms, such as headache, dizziness, or hunger), it is reasonable to aim for higher blood glucose levels than the ones recommended by the guidelines. It needs to be individualized.” At the other end of the spectrum are recommendations for pregnancy, when blood glucose levels need to be “as close to normal as possible,” she says.

It is, Rodbard says, “very important to check blood glucose… [and] it’s absolutely essential if you’re making changes to your regimen. We want to prevent the complications of diabetes. We want people to live longer and better lives, even with diabetes—and it’s perfectly feasible.”

“Will I need to take medicine?”
If your Type 2 diabetes cannot be managed with diet and exercise, you’ll probably be prescribed oral diabetes drugs. People with Type 1 diabetes must always use insulin because their bodies don’t make it anymore, and some people with Type 2 diabetes need insulin to control their blood glucose levels, too.

When you eat, your body converts the carbohydrate in the food into glucose, which is what your cells use for energy. Insulin’s job is to get the glucose out of your bloodstream and into your cells. But when you have diabetes, you either don’t make enough insulin or your body is not as sensitive to the insulin you do make as it used to be. Also, in many people with Type 2 diabetes, the body doesn’t release enough insulin when they first begin eating to keep their blood glucose levels down after the meal.

There are many types of oral diabetes drugs. Some slow down the absorption of carbohydrate from meals, some stimulate your body to make more insulin, some make your body more sensitive to insulin, and some have multiple purposes. You may be prescribed more than one oral medicine, or an oral medicine plus insulin. Be sure to ask your doctor the names of the drugs you’re being asked to take, how they work, and if any can cause low blood glucose (hypoglycemia). It’s also legitimate to ask for samples to take while it’s being determined what types of drug(s) work best for you. If you cannot afford the drugs you are prescribed, ask your doctor about the drug manufacturer’s patient assistance program—most have one. If you have Type 2 diabetes, it’s likely that, over time, your drug doses will be increased, more drugs may be added, or different drugs—including insulin—may be needed. That doesn’t mean that you haven’t been taking the right steps to manage your diabetes; it’s simply a natural progression of the condition.

If you are prescribed insulin, you will need instruction on how to balance insulin, food intake, exercise, and other factors. In short, eating makes your blood glucose level rise and insulin makes it come down. Exercise also can make your blood glucose come down (think of it as a natural insulin-sensitizer), while factors such as illness, infection, and even hormone levels can affect your body’s need for and response to insulin.

Jan Chait is a freelance writer in Terre Haute, Indiana.

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