Harvard Health Letter

By the way, doctor: Diabetes treatment

Q. I've had type 2 diabetes for 12 years; I'm now 81. I take metformin plus Januvia. My doctor has never suggested that I monitor myself on a daily basis with a meter. My hemoglobin A1c has been creeping up and is now at 7. Should I be getting more aggressive in my treatment?

A. You have type 2 diabetes, which used to be called adult-onset diabetes. This type of diabetes is caused mainly by insulin resistance. Normally, insulin helps usher blood sugar (which is the same thing as glucose) out of the bloodstream and into cells where it is used for energy. When people develop insulin resistance, cells turn away insulin, so the amount of sugar circulating in the blood goes up, and sugar-laden blood leads to numerous problems, including damage to the eyes, kidneys, and nerves and a higher risk of heart attacks and strokes.

You should congratulate yourself that after 12 years of having diabetes, your hemoglobin A1c level is still only 7. The hemoglobin A1c test measures the amount of sugar "stuck" to hemoglobin, a protein in red blood cells, and it reflects blood sugar levels over the previous several months. For most people with diabetes, the goal is to keep the hemoglobin A1c level at or below 7, which represents fairly tight control of blood sugar levels. Tight control can lead to dangerously low blood sugar (hypoglycemia) in older people, causing confusion, light-headedness, and fainting, so a hemoglobin A1c level of 8 or less can be a reasonable goal.

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