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Q.

My last A1c reading was 8.1. My doctor threatened insulin if I did not bring this down. Isn't this a little radical?

Related Topics: Insulin
 

Answers From Experts & Organizations (1)

Nutrition
Tufts Medical Center
44 Answers
3,042 Helpful Votes
36 Followers
A.

... The standard guidelines state clinicians should work closely with patients to do what it takes to keep the A1c at 7.0 or less. It is not good practice to let the A1c stay above 7.0 for very long.

In fact, if a patient has already tried to implement lifestyle changes and is already on metformin, the next step is to offer another oral drug or offer going directly to insulin without adding a second oral medication.

An alternative approach, which I certainly favor, is to work with the patient to take the lifestyle changes to a greater level. To accomplish this, most patients need some sort of a "wake up call" which helps them see the urgency and potential payoff of making such changes on a long-term basis.

Your doctor is trying to get you to make lifestyle changes so that you can get your A1c to 7.0 or less, otherwise you risk the fate of the vast majority of patiients with type 2 diabetes, specifically escalating doses of medication and/or increasing risk of complications such as blindness, limb loss, kidney failure and chronic dialysis, and premature heart disease or stroke. Your doctor is "threatening" you with insulin shots in order to jolt you into making lifestyle changes! He or she believes this is for your own good.

The good news is that a weight loss of about 5-10% or 10-20 pounds is typically enough to get the A1c down from 8 to 7 in my experience. To do so, I work with my own patients toward following an ambitious eating plan at the 90% strictness level, and aiming for 7 hours per week of exercise. Even if one can only be 80% strict and get 4 hours of exercise it typically makes a substantial difference. ...

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