Where Should Blood Sugar Control Really Be for Type 2 Diabetes?

by Michelle Magee, MD, Director of the MedStar Diabetes Institute
November 14, 2018

Hemoglobin A1C (A1C) is a way of looking at the average blood sugar levels over the preceding two to three months in people living with diabetes. And the American College of Physicians has published a new recommendation suggesting that some people with type 2 diabetes can safely raise their A1C level.

The update suggests the 29.1 million Americans with diabetes should aim for an A1C between 7 and 8 percent, an increase from the 6.5 to 7 percent that national guidelines from the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) recommend.

This change has come with critics, though, including myself. The ADA, AACE and the Endocrine Society have published statements challenging a broad relaxation the A1C target. I strongly agree with these national organizations, which are the voice of doctors who are specialists in treating diabetes. If a person’s blood sugar levels, as reflected in their A1C, are too high, they could be at increased risk over many years for:

  • Heart attack
  • High blood pressure
  • High cholesterol
  • Kidney failure
  • Leg amputation from infection
  • Stroke
  • Vision loss

Evidence shows that controlling your A1C to no greater than 7 percent lowers your risk for these diabetes-related complications. So, if the new guidelines are too loose, what targets for diabetes control are best for people with type 2 diabetes? And how can we make it easier for people to achieve their goal?

What’s a safe A1C for me?

Every person living with type 2 diabetes should have their own targets for blood sugar levels and A1C. You should speak with a doctor about what targets are best for you. During your visit, many things are taken into consideration including:

  • How many diabetes medications you are taking
  • Your age
  • Your physical activity levels
  • Whether you already have any diabetes complications

Generally, if you haven’t had diabetes for many years and you either have no, or very few, diabetes complications, you should aim for an A1C under 7 percent. However, people who are 65 years or older, have had trouble with severe low blood sugar reactions, or have had advanced diabetes complications might benefit from a more relaxed target A1C closer to 8.

Tips for managing your blood sugar and A1C levels

  1. Ask your doctor or diabetes educator about new ways to monitor and treat diabetes

Checking your own blood sugar levels with a fingerstick is becoming easier, as researchers continue to develop new ways to do so. Some of the latest innovations include:

  • The FreeStyle Libre: This is the first blood glucose meter that can read your blood sugar levels by waving the meter over an adhesive patch that sticks to your arm, rather than pricking your finger to get a drop of blood. This device records your blood sugar level every five minutes and shows you a graph of the results on its screen.
  • New medications: Several new classes of medications have come out relatively recently and can help people with type 2 diabetes maintain their target blood sugar levels. Some of these newer medications also provide protection against cardiovascular and kidney complications that can arise because of diabetes.
  1. Make sure you receive diabetes self-care education from a certified diabetes educator

Many health care organizations offer diabetes education, which your doctor can refer you to and is covered by most insurance plans.  Diabetes education is recommended when you are first diagnosed with diabetes, before and during pregnancy with diabetes, and any time your blood sugars are poorly controlled. People who receive diabetes education learn important information, such as lifestyle and medication tips, which helps them successfully take control of their diabetes.

Anyone in the MedStar Health system can access the MedStar Diabetes Institute’s Diabetes Self-Management Education program through their own primary care provider. Furthermore, people with type 2 diabetes and an A1C of 9 percent or higher, can participate in our three-month Diabetes “Boot Camp” upon a referral from your provider, which helps patients lower their A1C by an average of 3 percent. Protocol for the program can be found here.

For those with type 2 diabetes, have you spoken with your doctor about your specific average blood sugar level goal?

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Category: Living Well, Uncategorized     Tags: Wellness