When Should Insulin Be Started?
Q. Will my patient with type 2 diabetes require insulin? A. It varies from patient to patient. However, type 2 diabetes is a progressive disease marked by gradual loss of beta cell function and most patients will eventually require insulin therapy.1 This should be viewed as part of the pathophysiology of the disease and not as a failure on the part of the patient or healthcare provider. Insulin should be discussed early with patients who are beginning to show progression of their diabetes to ease the transition when the time to start insulin therapy arrives. This time should be considered part of a larger conversation between provider and patient, and not seen as a turning point down a path to the many severe complications of diabetes. Q. Is there a specific hemoglobin A1c (HbA1c) at which insulin must be started? A. No. Insulin, like all treatments for diabetes, should be started and adjusted to achieve a reasonable goal HbA1c for the patient. The American Diabetes Association (ADA) previously recommended that a patient’s HbA1c not be allowed to exceed 8%, creating an “action point” for escalation of therapy. However, population studies have shown that the burden of hyperglycemia due to reluctance to start or advance therapy is significant and put patients at risk of earlier complications.2 Newer guidelines recommend advancing therapy to a goal HbA1c, which is individualized to the patient’s needs (under 7% for most patients).3 If a patient’s HbA1c rises above target and does not respond to 2 or more oral hypoglycemic agents,4 changes in their regimen should be made sooner rather than later to prevent unnecessary hyperglycemia. If insulin is needed to achieve this goal, it should be started right away rather than waiting to see if other treatments will work w Continue reading >>
Economic Impact Of And Treatment Options For Type 2 Diabetes
Supplements > Utilizing Advances in Diabetes and Targeting Medication Adherence to Enhance Clinical Outcomes and M Diabetes and its various comorbidities are responsible for a substantial societal financial burden. Healthcare and managed care providers must take responsibility for and address the high healthcare costs attributed to diabetes care. They can work together to improve diabetes-related patient care and reduce costs. Newer therapeutic agents and those used as combination therapy may decrease direct costs by improving glycemic control and preventing negative outcomes associated with diabetes comorbidities. Additional diabetes education, increased time to review medication adherence and diabetes monitoring, and having affordable care are all necessary to improve the care of individuals with diabetes. The prevalence of diabetes continues to increase as more Americans live longer and the prevalence of obesity increases. As the prevalence and the associated costs of diabetes care increase, so does the national burden of this disease. Notably, of the 30.3 million Americans diagnosed with diabetes in 2015, an estimated 7.3 million were undiagnosed, despite the wide variety of agents currently available for the treatment and management of this disease.1 Several older diabetes therapies are guideline-supported, first-line options typically covered by prescription insurance with a low patient co-pay. However, there is still a huge, unmet need to appropriately use these agents for optimal patient care. Newer therapeutic agents may increase the number of patients achieving glycemic goals, which should reduce diabetes-related complications and thereby reduce the direct and indirect costs of care. Economic Burden and Impact of Diabetes The cost of treating diabetes in the U Continue reading >>
5 Ways To Lower Your A1c
For some, home blood sugar testing can be an important and useful tool for managing your blood sugar on a day-to-day basis. Still, it only provides a snapshot of what’s happening in the moment, not long-term information, says Gregory Dodell, MD, assistant clinical professor of medicine, endocrinology, diabetes, and bone disease at Mount Sinai Health System in New York City. For this reason, your doctor may occasionally administer a blood test that measures your average blood sugar level over the past two to three months. Called the A1C test, or the hemoglobin A1C test, this provides a more accurate picture of how well your type 2 diabetes management plan is working. Taking the A1C Test If your diabetes is well controlled and your blood sugar levels have remained stable, the American Diabetes Association recommends that you have the A1C test two times each year. This simple blood draw can be done in your doctor's office. Some doctors can use a point-of-care A1C test, where a finger stick can be done in the office, with results available in about 10 minutes. The A1C test results provide insight into how your treatment plan is working, and how it might be modified to better control the condition. Your doctor may want to run the test as often as every three months if your A1C is not within your target range. What the A1C Results Mean The A1C test measures the glucose (blood sugar) in your blood by assessing the amount of what’s called glycated hemoglobin. “Hemoglobin is a protein within red blood cells. As glucose enters the bloodstream, it binds to hemoglobin, or glycates. The more glucose that enters the bloodstream, the higher the amount of glycated hemoglobin,” Dr. Dodell says. An A1C level below 5.7 percent is considered normal. An A1C between 5.7 and 6.4 perce Continue reading >>
Why The A1c Test Is Important
The A1c is a blood test, done in a lab, that shows what your average blood sugar has been for the past 3 months. Other names for this test are glycosylated hemoglobin, glycohemoglobin, hemoglobin A1c, and HbA1c. How the A1c Test Works The glucose that the body doesn't store or use for energy stays in the blood and attaches to red blood cells, which live in the bloodstream for about 4 months. The lab test measures the amount of glucose attached to the red blood cells. The amount is the A1c and is shown as a percentage. Your A1c number can give you and your health care team a good idea of how well you've controlled your blood sugar over the previous 2 to 3 months. When you get your A1c result from a Kaiser Permanente lab, you'll also see another number called the estimated Average Glucose, or eAG. Understanding the eAG Your estimated Average Glucose (eAG) number is calculated from the result of your A1c test. Like the A1c, the eAG shows what your average blood sugars have been over the previous 2 to 3 months. Instead of a percentage, the eAG is in the same units (mg/dl) as your blood glucose meter. The chart shows the relationship between the A1c percentage and the eAG. If A1c % is: Your eAG is: 6 126 6.5 140 7 154 7.5 169 8 183 8.5 197 9 212 9.5 226 10 240 10.5 255 11 269 11.5 283 12 298 What the Numbers Mean The A1c and eAG reflect your average blood sugar over a period of time. These numbers help you and your doctor see how well your treatment plan is working. The higher your A1c and eAG numbers are, the higher your chances for having long-term health problems caused by consistently high blood sugar levels. These problems include heart attacks, strokes, kidney failure, vision problems, and numbness in your legs or feet. The lower your A1c and eAG numbers, the lower you Continue reading >>
Research On Type 2 Diabetes/ Prediabetes
Below you will find a growing collection of dietary research on type 2 diabetes treatment. JUMP TO: Overview | Blood sugar & A1c | Diet Recommendations | Low Carb vs. Low Fat | Weight Loss & A1C Diet Comparison | Carbohydrates | Fat & Cholesterol | Protein | DMP Blog Overview Most people think that when people get diagnosed with diabetes, that’s it, they’re destined to get progressively worse, take more meds and suffer bad health. That’s simply not the case! While type 2 diabetes is not reversible from a diagnostic standpoint (once a person has it, they have it), diabetes can be reversible from a physiological standpoint in many. That is, a person can work to gain excellent control of their blood sugar levels, keeping them within a normal healthy range so that they are functioning like a non-diabetic person. Research shows this is true and in our experience with members and subscribers, people are achieving this everyday, even if they’ve had diabetes for 20 years! NOTE: The majority of the research that follows is around type 2 diabetes treatment. It's important to differentiate ‘reduction of diabetes risk' from ‘diabetes treatment.' These are often lumped into the same category but they are two very different concepts. Here our main focus of research is on diabetes treatment, along with prediabetes diet and lifetsyle interventions. Blood Sugar & A1C BLOOD SUGAR: Blood sugar is a measure of glucose/ sugar in the blood at any one time. Throughout the day blood sugar can fluctuate in response to numerous factors, mainly food but also exercise, stress, sleep, medications and so forth. The body is designed to maintain blood sugar levels in a healthy range. And it is well established that diabetics and prediabetics should work toward the goal of having blood suga Continue reading >>
Understanding Your Average Blood Sugar
A1c is an average of all your blood sugars. It does not tell you your blood sugar patterns. Use it only as yet another indicator of how well you’re doing. Glysolated Hemoglobin (or A1c) is a measure of your average blood glucose control over the previous three months. Glucose attaches to hemoglobin the oxygen carrying molecule in red blood cells. The glucose-hemoglobin unit is called glycosolated hemoglobin. As red blood cells live an average of three months, the glycosolated hemoglobin reflects the sugar exposure to the cells over that time. The higher the amount of glucose in the blood, the higher the percentage of hemoglobin molecules that will have glucose attached. Think of the A1c as a long-term blood glucose measure that changes very gradually as red blood cells die and are replaced by new cells. The A1c doesn’t replace self blood-glucose monitoring. Because the A1c is an average of all your blood sugars, it does not tell you your blood sugar patterns. For example, one person with frequent highs and lows can have the same A1c as another person with very stable blood sugars that don’t vary too much. So what’s the point? A1c is yet another indicator of how well you’re doing. An A1c measurement between 4-6% is considered the range that someone without diabetes will have. The American Diabetes Association goal is an A1c less than 7%. Research has shown that an A1c less than 7% lowers risk for complications. The American College of Endocrinology goal is an A1c less than 6.5%. For some people with diabetes an A1c goal of less than 6% is appropriate. Talk with your doctor about your A1c goal. Use this chart to view A1c values and comparable blood glucose values: A1c Estimated Average Glucose mg/dL 5% 97 6% 126 7% 154 8% 183 9% 212 10% 240 11% 269 12% 298 A not Continue reading >>
Sglt2 Inhibitors: A New Treatment Option For Type 2 Diabetes
Introduction Diabetes mellitus is a chronic disease often requiring complex treatment regimens to prevent long-term complications.1 In 2010, it was estimated that 18.8 million adults and children in the United States were diagnosed with diabetes and another 7 million went undiagnosed, with the prevalence of diabetes expected to increase significantly by 2050.2,3 Various classes of medications have been approved by the FDA for the treatment of diabetes; however, few highly effective options are available with minimal adverse effects.1 Thus, the search continues for improved diabetes therapies. The FDA recently approved 2 medications from a novel class called sodium- glucose cotransporter 2 (SGLT2) inhibitors. This article will detail the characteristics of these agents, summarize the evidence leading to their approval, describe their current place in therapy, and discuss ongoing research involving this novel class. SGLT2 Inhibition Each day, approximately 180 g of glucose are filtered from the glomeruli of a healthy adult, and almost all of the filtered glucose is reabsorbed from the glomerular filtrate and returned to the circulation.4 Of the filtered glucose, 90% is reabsorbed in the bloodstream by the SGLT2, located primarily in the luminal membrane of the proximal renal tubules.5 The cotransportation of glucose and sodium from the filtrate is driven by the active transport of sodium out of the basolateral cells by the Na/K-ATPase pump.4 Glucose is also transferred out of the cell with the concentration gradient and subsequently returned to the bloodstream by glucose transporters. In type 2 diabetes mellitus (T2DM), renal glucose handling and transport is increased, likely due to upregulation of SGLT2. As a result, glucose excretion in the urine occurs only at higher Continue reading >>
Glycated hemoglobin (hemoglobin A1c, HbA1c, A1C, or Hb1c; sometimes also referred to as being Hb1c or HGBA1C) is a form of hemoglobin that is measured primarily to identify the three-month average plasma glucose concentration. The test is limited to a three-month average because the lifespan of a red blood cell is four months (120 days). However, since RBCs do not all undergo lysis at the same time, HbA1C is taken as a limited measure of 3 months. It is formed in a non-enzymatic glycation pathway by hemoglobin's exposure to plasma glucose. HbA1c is a measure of the beta-N-1-deoxy fructosyl component of hemoglobin. The origin of the naming derives from Hemoglobin type A being separated on cation exchange chromatography. The first fraction to separate, probably considered to be pure Hemoglobin A, was designated HbA0, the following fractions were designated HbA1a, HbA1b, and HbA1c, respective of their order of elution. There have subsequently been many more sub fractions as separation techniques have improved. Normal levels of glucose produce a normal amount of glycated hemoglobin. As the average amount of plasma glucose increases, the fraction of glycated hemoglobin increases in a predictable way. This serves as a marker for average blood glucose levels over the previous three months before the measurement as this is the lifespan of red blood cells. In diabetes mellitus, higher amounts of glycated hemoglobin, indicating poorer control of blood glucose levels, have been associated with cardiovascular disease, nephropathy, neuropathy, and retinopathy. A trial on a group of patients with Type 1 diabetes found that monitoring by caregivers of HbA1c led to changes in diabetes treatment and improvement of metabolic control compared to monitoring only of blood or urine glu Continue reading >>
Early Intensive Blood Sugar Control Lengthens Life In People With Type 1 Diabetes
The findings of this important paper emphasize one specific word: early. It is important to treat these patients with type 1 aggressively and early, when they are either adolescent or young adults, or as soon as they are diagnosed if they are diagnosed in their 20s. This article reveals without a doubt how complications are a reality if the blood glucose is not controlled early in life or in the first 10 years of the condition. Closely controlling blood sugar levels early in the treatment of type 1 diabetes was linked to a lower risk of death later in life, according to findings from a study that followed people with type 1 diabetes for approximately 27 years. The findings were published in the January 6 issue of JAMA. "The outlook for people with type 1 diabetes continues to improve," said Catherine Cowie, PhD, of NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which funded the study. "These results show that by tightly controlling their blood glucose, people with type 1 diabetes can live longer," Dr. Cowie said. Study Design The study authors examined data from a 1983-1993 study of 1,441 healthy volunteers with type 1 diabetes (ages 13 to 39 years) who were given either intensive treatment designed to bring blood sugar levels as close to normal as possible, or conventional treatment that was designed to avoid the symptoms of high blood sugar (hyperglycemia) or low blood sugar (hypoglycemia). At the beginning of the study—known as the Diabetes Control and Complications Trial (DCCT)—none of the participants had complications of diabetes, such as heart disease or eye, nerve, or kidney disease. Intensive therapy was linked to lower blood sugar level (hemoglobin A1c) compared with conventional treatment (7% vs 9%). In addition, people gi Continue reading >>
- NIHR Signal Insulin pumps not much better than multiple injections for intensive control of type 1 diabetes
- Can an online game really improve blood sugar control for people with diabetes?
- Maternal obesity as a risk factor for early childhood type 1 diabetes: a nationwide, prospective, population-based case–control study
Diabetes Mellitus Treatment
In patients diagnosed with diabetes mellitus (DM), the therapeutic focus is on preventing complications caused by hyperglycemia. In the United States, 57.9% of patients with diabetes have one or more diabetes-related complications and 14.3% have three or more. Strict control of glycemia within the established recommended values is the primary method for reducing the development and progression of many complications associated with microvascular effects of diabetes (eg, retinopathy, nephropathy, and neuropathy), while aggressive treatment of dyslipidemia and hypertension further decreases the cardiovascular complications associated macrovascular effects.[2-4] See the chapter on diabetes: Macro- and microvascular effects. Glycemic Control Two primary techniques are available to assess a patient's glycemic control: Self-monitoring of blood glucose (SMBG) and interval measurement of hemoglobin A1c (HbA1c). Self-Monitoring of Blood Glucose Use of SMBG is an effective method to evaluate short-term glycemic control. It helps patients and physicians assess the effects of food, medications, stress, and activity on blood glucose levels. For patients with type 1 DM or insulin-dependent type 2 DM, clinical trials have demonstrated that SMBG plays a role in effective glycemic control because it helps to refine and adjust insulin doses by monitoring for and preventing asymptomatic hypoglycemia as well as preprandial and postprandial hyperglycemia.[2,5-7] The frequency of SMBG depends on the type of medical therapy, risk for hypoglycemia, and need for short-term adjustment of therapy. The current American Diabetes Association (ADA) guidelines recommend that patients with diabetes self-monitor their glucose at least three times per day. Those who use basal-bolus regimens should s Continue reading >>
Insulin For Type 2 Diabetes: Who, When, And Why?
Physicians who treat people with type 2 diabetes face difficult choices when selecting the best medical therapy for each patient. The decision process is further complicated by the fact that because type 2 diabetes is a progressive disease, therapeutic agents that were initially successful may fail five or ten years later. As recently as 1994, there were only two options for patients with type 2 diabetes: insulin and the sulfonylureas (such as glyburide and glipizide). The good news is that today, seven totally different classes of medications are available, as well as much better insulins. The bad news is that many physicians are more confused than ever, especially when faced with the option of combining two, three, or even more drugs at one time. In addition, the past several years have seen the advent of six combination drugs (such as Glucovance, Avandamet, and Janumet), with more on the way. Faced with this explosion of therapeutic options, many physicians are reluctant to start insulin therapy even when it is clearly indicated. Insulin Resistance and Deficiency in Type 2 Diabetes Most patients with type 2 diabetes suffer from two major defects: insulin resistance and beta cell “burnout.” Insulin resistance typically precedes outright diabetes by several years, appearing in adults and children who are overweight, sedentary, and have a genetic predisposition to diabetes. Patients with insulin resistance are often diagnosed with the metabolic syndrome, which predisposes them to both type 2 diabetes and cardiovascular disease. When food is ingested, insulin is secreted by the beta cells into the bloodstream. The insulin travels to the liver or muscles, where it attaches to receptors on the surface of the cells like a key in a lock. In non-diabetic people, this proc Continue reading >>
- Stressing The Difference Between Type 1 And Type 2 Diabetes: Why Do We Care?
- This is why it's so important to know the difference between Type 1 and Type 2 diabetes
- Relative contribution of type 1 and type 2 diabetes loci to the genetic etiology of adult-onset, non-insulin-requiring autoimmune diabetes
What Is A1c? - Topic Overview
A1c is a test that shows the average level of blood sugar over the past 2 to 3 months. People who have diabetes need to have this test done regularly to see whether their blood sugar levels have been staying within a target range. This test is also used to diagnose diabetes. A1c test results show your average blood sugar level over time. The result is reported as a percentage. Your goal is to keep your hemoglobin A1c level as close to your target level as possible. You and your doctor will work together to set your safe target level. The result of your A1c test can also be used to estimate your average blood sugar level. This is called your estimated average glucose, or eAG. Your eAG and A1c show the same thing in two different ways. They both help you know about your average blood sugar over the past 2 to 3 months. The table below shows A1c with estimated average glucose. 1 A1c and estimated average glucose (eAG) Hemoglobin A1c % Estimated average glucose (mg/dL) 6% 126 7% 154 ADVERTISINGinRead invented by Teads 8% 183 9% 212 10% 240 11% 269 12% 298 This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.© 1995-2015 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Continue reading >>
Average blood glucose and the A1C test Your A1C test result (also known as HbA1c or glycated hemoglobin) can be a good general gauge of your diabetes control, because it provides an average blood glucose level over the past few months. Unlike daily blood glucose test results, which are reported as mg/dL, A1C is reported as a percentage. This can make it difficult to understand the relationship between the two. For example, if you check blood glucose 100 times in a month, and your average result is 190 mg/dL this would lead to an A1C of approximately 8.2%, which is above the target of 7% or lower recommended by the American Diabetes Association (ADA) for many adults who are not pregnant. For some people, a tighter goal of 6.5% may be appropriate, and for others, a less stringent goal such as 8% may be better.1 Talk to your doctor about the right goal for you. GET YOURS FREE The calculation below is provided to illustrate the relationship between A1C and average blood glucose levels. This calculation is not meant to replace an actual lab A1C result, but to help you better understand the relationship between your test results and your A1C. Use this information to become more familiar with the relationship between average blood glucose levels and A1C—never as a basis for changing your disease management. See how average daily blood sugar may correlate to A1C levels.2 Enter your average blood sugar reading and click Calculate. *Please discuss this additional information with your healthcare provider to gain a better understanding of your overall diabetes management plan. The calculation should not be used to make therapy decisions or changes. What is A1C? Performed by your doctor during your regular visits, your A1C test measures your average blood sugar levels by taking a Continue reading >>
Symptoms, Diagnosis & Monitoring Of Diabetes
According to the latest American Heart Association's Heart Disease and Stroke Statistics, about 8 million people 18 years and older in the United States have type 2 diabetes and do not know it. Often type 1 diabetes remains undiagnosed until symptoms become severe and hospitalization is required. Left untreated, diabetes can cause a number of health complications. That's why it's so important to both know what warning signs to look for and to see a health care provider regularly for routine wellness screenings. Symptoms In incidences of prediabetes, there are no symptoms. People may not be aware that they have type 1 or type 2 diabetes because they have no symptoms or because the symptoms are so mild that they go unnoticed for quite some time. However, some individuals do experience warning signs, so it's important to be familiar with them. Prediabetes Type 1 Diabetes Type 2 Diabetes No symptoms Increased or extreme thirst Increased thirst Increased appetite Increased appetite Increased fatigue Fatigue Increased or frequent urination Increased urination, especially at night Unusual weight loss Weight loss Blurred vision Blurred vision Fruity odor or breath Sores that do not heal In some cases, no symptoms In some cases, no symptoms If you have any of these symptoms, see your health care provider right away. Diabetes can only be diagnosed by your healthcare provider. Who should be tested for prediabetes and diabetes? The U.S. Department of Health and Human Services recommends that you should be tested if you are: If your blood glucose levels are in normal range, testing should be done about every three years. If you have prediabetes, you should be checked for diabetes every one to two years after diagnosis. Tests for Diagnosing Prediabetes and Diabetes There are three ty Continue reading >>
Is Insulin The Preferred Treatment For A1c > 9%?
Abstract The algorithms/guidelines of the American Association of Clinical Endocrinologists and of the American Diabetes Association recommend that insulin administration be strongly considered for persons with type 2 diabetes (T2D) having HbA1c levels exceeding 9.0% ((1) ) and 10% ((2) ), respectively. Continue reading >>