Charlotte, NC
Mose July, MD
Shruti Kumari, MS4
Mike is a 45-year-old man recently diagnosed with diabetes. He was prescribed metformin and insulin by his primary care provider. He is concerned that the insulin will lower his blood sugar. What advice do you have for him?
Diabetes mellitus is a chronic disease where your body has high glucose levels. The defect either lies in the pancreas (your insulin factory), or your body cannot use insulin efficiently. We understand that a new diagnosis of diabetes can be scary but don’t let it stop you and your family from living a healthy life.
The symptoms of diabetes are caused by rising blood sugar levels in your bloodstream. Your blood sugar may be high during a random check-up. Most people experience excessive thirst, fatigue, frequent infections, or unintentional weight loss. You might experience signs of poor circulation, including tingling or numbness in the hands and feet, wounds that do not heal, or blurred vision. Many people with type 2 diabetes show no symptoms, but your doctor can help detect diabetes during an annual checkup or while testing for other medical problems.
Insulin is a hormone our body needs to get glucose from the bloodstream into the body’s cells.
Type 1 diabetes: Your body does not produce insulin.
Type 2 diabetes: Your body doesn’t use insulin properly.
Gestational diabetes is detected during pregnancy during a routine blood sugar test or oral glucose tolerance test performed between the 24th and 28th weeks of gestation.
Random blood sugar test: This involves checking blood samples at random times. If the blood sugar level is 200 milligrams per deciliter (mg/dL) or more, you may have diabetes.
Fasting blood sugar test: A blood sample will be taken after overnight fasting. A fasting blood sugar level of less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes. If the fasting blood sugar is 126 mg/dL or higher on two separate tests, you have diabetes.
HbA1c: This blood test shows average blood sugar levels over the past two to three months. An HbA1C between 5.7% and 6.4% means that you have prediabetes, while below 5.7% is considered normal. If you have HbA1c of 6.5% or higher on two separate tests, you have diabetes.
Many people control their blood sugar levels with lifestyle changes, including weight loss, healthy eating, and exercise. However, some may need medication or insulin to maintain their blood sugar levels. Balanced nutrition, daily physical activity, avoiding smoking, frequent blood sugar monitoring, and regular monitoring of HbA1c are cornerstones of treatment for both type 1 and type 2 diabetes mellitus.
Things to know about treating diabetes:
High blood sugar levels can place you at risk for heart disease, stroke, kidney failure, vision and nerve problems, skin ulcers, and infections.
Lowering blood sugar levels to achieve desired hemoglobin A1c (HbA1c) is vital to reduce the risk of these serious complications.
You will need a glucometer to measure your blood sugar levels at home. The blood glucose meter is like a powerful little home laboratory that can fit in your pocket. All you need to do is add a tiny drop of blood, and the meter will show your blood glucose level on a display screen.
How often you check your blood glucose level depends on your diabetes type, control, and whether you are taking insulin or not. Blood sugar levels are expected to range between 90- 120 mg/dl when fasting and less than 140mg/dl after a meal (postprandial) when your diabetes is under control. We recommend checking your blood sugar at least twice daily and maintaining a logbook of your blood sugar levels. Consistently logging your blood sugar levels in a diary can help inform your medication regimen for your primary care provider or endocrinologist.
Steps of checking blood sugar at home blood
If you have Type 1 diabetes or uncontrolled type 2 diabetes, you might benefit from continuous glucose monitors (CGMs) that check your blood glucose regularly. CGMs report your blood glucose levels in real-time, alert you when your glucose hits a high or a low limit and can track your glucose levels. The CGMs can also help you track your blood sugar levels in compatible smartphones.
HbA1c is a blood test that shows average blood sugar levels over the past two to three months. Hb A1c can diagnose diabetes or monitor how well your diabetes treatment plan works. Your primary care provider can take it as a guide to formulate a game plan to manage your diabetes.
It is best to get Hb A1c tested at least twice every year. If you’re not meeting your goals or changing treatments, you may need an Hb A1C test more often.
The American Diabetes Association suggests a target A1C of 7% for nonpregnant adults. Elderly patients with various medical conditions can have a higher target of less than 8%.
The health benefits of lowering HbA1c levels to below 7 % in older people are uncertain. Please note that lowering HbA1c may increase your risk for hypoglycemia. When we age, our kidneys become less efficient, which causes insulin (or other drugs) to accumulate in the body. Older people also often take multiple medicines, some of which may interact with diabetes medication and contribute to hypoglycemia. Hypoglycemia (severely low blood sugar) can result in confusion, coma, falls, hospitalizations, and even death. Elderly patients with various medical conditions can have a higher target of less than 8%.
Since it depends on the individual and external, it is never the same target for every individual. Talk to your doctor regarding maintaining your A1c in a healthy range with lifestyle changes and medications.
Hypoglycemia is a condition where blood glucose levels in the body are low. You will have symptoms of hypoglycemia when your blood glucose is less than 70 mg/dL. If you are at home, you need to act NOW. Hypoglycemia is a life-threatening emergency.
Signs of Hypoglycemia
The only way to ensure you are experiencing low blood glucose is to check your blood glucose levels. If you are experiencing symptoms of low blood sugar and cannot check your blood glucose for any reason, treat hypoglycemia instead. You can do this by taking glucose tablets, drinking juice, or eating food that can raise your blood sugar level. Your doctor might prescribe glucagon, which can be given as an injection by a family member if you are unresponsive at home. If you have frequent hypoglycemia attacks, seek medical attention. If you take a medication that can cause hypoglycemia, your doctor might be able to adjust your medication dose.
The best way to prevent hypoglycemia is to monitor your blood glucose levels closely. When you see blood glucose levels dropping, you can treat it before it gets too low.
We recommend maintaining a logbook of your blood glucose recordings. Blood glucose levels can be checked before and after meals, before and after exercises, early in the morning, and before bed. If you have a new insulin routine, change in medications, or a new work schedule, check your blood glucose more frequently. Talk to your doctor if you see low blood glucose levels.
Insulin pumps are additional devices attached to your body that are programmed to mimic your body’s normal release of insulin. The pump can deliver insulin continuously or as a surge (bolus) close to mealtimes. This delivery method can control the rise in blood sugar after a meal. Using a pump doesn’t mean you no longer have to check your blood sugar. It can take some time to get used to the pump.
Talk to your provider if an insulin pump is best for you. Check with your insurance provider if your doctor determines that an insulin pump is a good option for you. Most insurance providers cover insulin pumps, but sometimes they may not be covered and can be expensive.
