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Kos Diabetes Group: Is Your Diabetes Being Treated Aggressively Enough? [1]

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Date: 2022-07-29

When managing diabetes your A1c is an indication of your estimated average glucose (eAG) level, the same numbers you’re used to seeing on your glucose monitor.

A1C % eAG mg/dL 7 154 8 183 9 212 10 240

Now I don’t know about you, but I don’t feel that an A1c of 7 with the implied average glucose reading of 154 is either healthy or under control. Why would I want my A1c with treatment to still be in the range that would get me diagnosed as diabetic? Neither my husband nor I could understand why patients and/or doctors would be happy with those numbers. Both my husband and I had A1cs over 11 when we were diagnosed. He had to start taking insulin right away because his fasting level was almost 400. My fasting level was about 250. In three months both of us had managed to get our A1cs down below 6.5 by taking our medication and watching what we ate. We both have A1cs below 6 now.

We didn’t think we did anything out of the ordinary. We just wanted our numbers to come down to normal as soon as possible because we knew it would be better for our health. We weren’t starving ourselves, we weren’t exercising non-stop. We did change our diet some. We switched to diet sodas, used Splenda instead of regular sugar, watched how many carbs we ate at each meal, and looked for low carb versions of our favorite desserts. We took our medication as directed and increased dosages and added on other medications until we got the desired effect.

I know that when I was diagnosed my practitioner asked me where I wanted my numbers to be and I told her I wanted my fasting level to be about 100 and my post prandial to be under 165. It was what the endocrinologist I saw when I had gestational diabetes told me I should aim for and if it was good enough then, I felt it would be good enough now. I started on 500mg of metformin once a day for a week because both my father and my sister had terrible side effects (non-stop diarrhea) from it and had to switch to other medications. I was told I could go to 1000mg after a week if I didn’t have any side effects. My numbers started to improve after two weeks but still were higher than what I wanted so we upped my dose of metformin to 2000mg/daily. That got my post prandials down under 165 but my fasting levels were still high so in two more weeks I tried adding 10mg of Jardiance. That helped with my fasting levels but they were still in the 115-120 range so in two weeks I went to the 25mg dose of Jardiance and that did the trick.

My husband took metformin with his insulin but his numbers were still a little high so he later added Januvia and then Jardiance to his regimen.

So here’s what we have a hard time wrapping our heads around — why do doctors seem happy with A1cs way over 7 and why aren’t they asking their patients to try adding on some of the other medications that are available to bring their numbers down to the normal range? And also, why aren’t more patients questioning the guidance they are getting from their providers if their numbers are still high and their doctor isn’t trying to get them to take additional medications to improve their numbers? My doctor treats me like what I’ve done is some kind of weird anomaly. I can’t understand why she wouldn’t want the same results for all her diabetic patients. (please note that I had to switch providers within the practice about six months after my diagnosis because my original provider left the practice to go into mental health work. My original provider is the one who helped me set up my medication regimen and it hasn’t changed since then).

I hope I’m not coming off sounding harsh. I understand that some people really struggle to get their numbers down, but I don’t understand why they aren’t looking for additional medications that will help if they aren’t taking the maximum dosages for oral medication or haven’t tried an add on therapy or insulin. I know that if the oral medication didn’t do the trick for me, I would have asked to start insulin because I know it’s healthier for me to have numbers closer to the normal range. If you have high blood pressure and the doctor starts you on a medication for it but it doesn’t bring your readings down enough they would definitely increase the dosage or try another medication to get your blood pressure back to a normal reading because it’s not good for you to have high blood pressure. I don’t understand why most doctor’s don’t seem to treat diabetes the same way. It seems that they start patients on some medication and if their numbers come down some it’s good enough and the doctors don’t press to get them down to normal.

I know some diabetics who are unhappy with their numbers but they aren’t taking the maximum dosage of metformin or any other add on medications and I always ask them “Why?” Have you asked your doctor if you can take a higher dosage of your current medication to see if that will help your numbers or can you add on another oral medication to see if that will help.

How happy are you with how aggressively your doctor is treating your diabetes? Do you feel like your numbers could be better if you increased your medications or added on something new?

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[1] Url: https://www.dailykos.com/stories/2022/7/29/2113180/-Kos-Diabetes-Group-Is-Your-Diabetes-Being-Treated-Aggressively-Enough

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