PITTSBURGH (KDKA) — Keeping your diabetes in check can be tough, and doctors are divided on the best treatment options. So what’s best for you?
Angela Noel, of Penn Hills, has Type 2 diabetes. She has struggled to keep her blood sugar in a specified range, especially after having a baby.
A blood test called an A1C, which reflects a three-month average, shot way up.
“It got to 12s and 13s, which is where you don’t want to be,” Noel said.
She worries about the sugar being too high.
“My vision, even with my glasses, will start getting a little fuzzy around the edges,” she said.
Noel has reined in her readings, sometimes a little too much.
“I can tell when I’m getting too low because then I start to shake as well,” she said.
More recently, her A1C has been in the 7 to 8 range — good numbers.
But not everyone might do so well with the same test results. In fact, a controversy is brewing about how tightly to control blood sugar.
One set of guidance comes from the American Diabetes Association and doctors who are diabetes specialists. They favor tight control.
“The closer your A1C gets to 7 percent or less, the less chance you have of complications,” Allegheny Health Network endocrinologist Dr. Patricia Bononi said, “but sometimes, it’s not easy to get there.”
Another line comes from the internists.
“The American College of Physicians, which represents internal medicine, has general recommended a target of around 7 percent,” AHN internist Dr. Marc Itskowitz said.
The ACP has recently issued guidelines to aim for A1Cs between 7 and 8 in people with Type 2 diabetes. This is based on a review of data regarding the benefits and harms of treatments for diabetes.
Blood sugars that dip too low can lead to shakiness, falling, confusion and passing out.
“You have older patients, patients who may forget to eat, patients who don’t check their blood sugar,” Itskowitz said. “We have to be more careful about these aggressive targets.”
Keeping sugars on the low side doesn’t help when it comes to dreaded complications of diabetes.
“There’s not good evidence that a stricter target actually helps patients in terms of prevention of heart attack and stroke,” Itskowitz said.
Severely and chronically high blood sugars can damage organs and tissues, such as the kidneys, eyes and nerves, but not at the range the internists are advocating.
“In primary care, we’re balancing not just the diabetes, but all the other medical conditions,” Itskowitz said.
“I’m really excited about where I am now,” Noel said. “It gives me hope.”
Noel says both her primary care and diabetes doctors are happy, too. They agree she’s on the right track.