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Honored Contributor
Posts: 25,929
Registered: ‎03-09-2010

I know diabetes treatment is subjective but ...

My DH had Dr appt today. He had been told to keep a record of his blood sugars for a month and he did.He varied the times of day and his lowest of all was 138.The doctor praised him telling him he was doing great. A month ago I was diagnosed with diabetes and told I have to have  FBS of less than 90 and I am only allowed to be up to 110 after eating. I asked why the difference and the doctor said each is individual. Meanwhile my DH drinks and eats what he wants when he wants. And he has been on metformin and glucovance for 15 years. Up to this point my highest blood sugar has been 143,and that was an AM one when they are always high.I guess there is something I just don't get.

Trusted Contributor
Posts: 1,489
Registered: ‎03-18-2010

Re: I know diabetes treatment is subjective but ...

I'm on Metformin and glizipde.  Had to go on insulin because my blood sugars too high.  I thought 120 was the rule after 2 hours after breakfast.  I was told that I should get my blood sugar down to 140 or less in the morning (before breakfast).  90 sounds too low to me.  At 80 you better drink some orange juice.

Honored Contributor
Posts: 25,929
Registered: ‎03-09-2010

Re: I know diabetes treatment is subjective but ...

[ Edited ]

They keep lowering the numbers. It is now FBS are to be 75 to 90.Pre meals can be 110 the 2 hour after eating 120.

IMO these are not obtainable goals but they are what we were given in class.A couple days ago I came home from my walk all sweaty and shaky and my sugar was 75. 

Contributor
Posts: 48
Registered: ‎04-27-2015

Re: I know diabetes treatment is subjective but ...

If you are unsure of the treatment you are getting, you can and should ask for a referral to a specialist. Long story short, my husband died 18 months ago at home after struggling with diabetic neuropathy for about 2 1/2 years and getting no answers from the doctors at the VA. Saddest part is, he worked there. I couldn't get it thru his head that his loyalty was getting him nowhere and that he needed to take charge of his healthcare. The man spent 23 years in the Navy and 23 years at Naval and VA hospitals and now his ashes reside in the National Cemetary in Beaufort, SC. Diabetes is no joke, and has many symptoms and side effects. Look up Charcot Foot images and ask your husband if it looks like fun. I am not trying to be nasty but people trust doctors to advise them and sometimes that's not enough. Good luck and God Bless.

Honored Contributor
Posts: 10,944
Registered: ‎09-01-2010

Re: I know diabetes treatment is subjective but ...

I too have seen individuality play into diabetes treatments.   My husband was diagnosed 20 years ago, and is classified as having advanced diabetes with issues like peripheral artery disease.  He has COPD, and uses steroids daily, which impact his blood sugar readings.   He keeps a daily log of his readings, and his doctor is thrilled to see any numbers under 150.   The target goal for his A1c is 8.0; it is unrealistic to expect him to achieve much lower than that at this stage of the disease.   

 

I was diagnosed with pre diabetes 6 years ago, and based on an extensive family history, I have chosen to be aggressive with my treatment.   I watched 2 of my husbands doctors, who I trusted implicitly, take a "wait and see" approach, that ultimately did not turn out well for my husband, and is responsible for some of his current issues.   I think an aggressive approach, which already includes insulin, is appropriate for me----my target goal for A1c is 7.0.

 

My 63 year old cousin has been diabetic 10 years.  His doctor pushes him to follow certain Atkins diet guidelines, which is mainly very heavy on meats, and only certain vegetables.  He does not eat any starchy vegetables, no pasta, no sauces, and no bread.   My cousin is very rigid with following this diet, and his A1c runs between 5.8 and 6.0.   

 

 

Honored Contributor
Posts: 13,115
Registered: ‎12-07-2012

Re: I know diabetes treatment is subjective but ...

[ Edited ]

I just recently completed a series of classes that is sponsored by one of our hospitals, and the instructor is an RN trained in diabetes management. She gave us the following blood glucose targets over and over. Mornings fasting 90-130. 2 hours post meal less than 180. An A1C is very telling, and should be no higher than a 7 ideally. She said women should have 3 servings of carbs with each meal. That would be 45 carbs per meal. She emphasized having protein with meals, and non starchy vegs don't count unless you eat more than 3.5 servings raw or 1.5 cups cooked. 

Trusted Contributor
Posts: 1,973
Registered: ‎03-09-2010

Re: I know diabetes treatment is subjective but ...

From the Joslin center:

manage your condition.

Time of Check

Goal plasma blood glucose ranges
for people without diabetes

Goal plasma blood glucose ranges
for people with diabetes

Before breakfast (fasting)

< 100

70 - 130

Before lunch, supper and snack

< 110

70 - 130

Two hours after meals

< 140

< 180

Bedtime

< 120

90- 150

A1C (also called glycosylated hemoglobin A1c, HbA1c or glycohemoglobin A1c)

< 6%

< 7%

 

< = less than
> = greater than
> = greater than or equal to
< = less than or equal to

Information obtained from Joslin Diabetes Center's Guidelines for Pharmacological Management of Type 2 Diabetes.

 

Honored Contributor
Posts: 18,504
Registered: ‎05-23-2010

Re: I know diabetes treatment is subjective but ...

[ Edited ]

Every doctor follows different guidelines. Different diabetes centers (Joslin and others) have different guidelines. There is no one common set of nationally recommended guidelines, and that aspect, and the different figures, are getting worse all the time.

 

When I was first diagnosed I was very active on a diabetes forum and paid close attention to what *most* people's doctors recommended. They were all pretty close, for type 2s.  But that has changed. Now the recommendations are all over the map from low to high, depending on what recommendation-of-the-month a doctor follows. It's frustrating for the patient, to say the least.

 

Starting out, I was told 120 or less on waking, 140 or less 2 hrs after meals, and A1C of 6.5 or less. It's much more lenient now, and I don't think that's a good thing.

Life without Mexican food is no life at all
Honored Contributor
Posts: 25,929
Registered: ‎03-09-2010

Re: I know diabetes treatment is subjective but ...

My highest ever A1c has never been 7. Highest ever 6.7.Highest ever FBS was 141.Based on those numbers I was diagnosed.The ADA says to be diagnosed you need a A1c greater than 7 twice. I think this doctor and I need to talk.

But  beside that ,I don't feel he is managing my DH well. Telling him how well he is doing when he is not really at all.My husband refuses to entertain any ideas different than what he learned 15 years ago.

Honored Contributor
Posts: 13,115
Registered: ‎12-07-2012

Re: I know diabetes treatment is subjective but ...

My type 2 diagnosis came with a FBS of 141, and I was put on Metformin extended release. My A1C' s have not shown to be higher than 6.1. The A1C being a 7 means that would be the highest acceptable readout for a type 2. These are the numbers I have been taught for the past 8 years, and very recently as well. Denial is common when someone is diagnosed.