Shoot for the goal

Shoot for the goal
Diabetes treatments aim to lower blood glucose and reduce complications

By Cynthia N. Lank

The goal of diabetes treatment is to prevent complications from developing or to slow down their progression. Treatment targets include lowering blood glucose levels and blood pressure and reducing the LDL (“bad”) cholesterol. Use the table on page 4 to learn more about the medications that can help you lower your blood glucose levels.

Monitoring blood glucose levels
Blood glucose levels are commonly measured in two ways — with a laboratory blood test and by self-monitoring with a blood glucose meter. The A1C laboratory test is a measurement of the average of your blood glucose levels over the previous three months. The table below lists the recommended targets for A1C and blood glucose levels determined through self-monitoring.

Treating high blood glucose levels
To lower blood glucose levels, lifestyle modifications are important and provide benefits beyond managing diabetes. However, lifestyle changes alone are often not enough to lower blood glucose levels to the recommended targets. If healthy eating and increased activity do not bring your blood glucose levels to target within two or three months, the Canadian Diabetes Association’s Clinical Practice Guidelines recommend starting drug therapy. The longer that blood glucose levels stay above a healthy
level, the higher the risk of developing complications.

If you have type 1 diabetes, you will always require insulin. If you have type 2 diabetes, you will be asked to make lifestyle changes and may be treated with pills and/or insulin. As type 2 diabetes results from both insulin resistance (the body’s inability to use insulin properly) and insulin deficiency (due to the pancreas’ inability to secrete enough insulin), it often requires treating both problems. For this reason, you may need two or three medications to manage your blood glucose levels.

The Clinical Practice Guidelines recommend the following approaches to managing high blood glucose
levels in type 2 diabetes. The goal: to lower your A1C to 7% or lower within 6 to 12 months.

Getting off to a good start
When you find out that you have diabetes, your doctor will choose medications based on how high your blood glucose levels are. If they’re very high (an A1C of 9% or above), it’s important to quickly lower them to the target of 7% or lower; this requires immediate treatment with at least two pills or insulin. If pills are preferred, the Clinical Practice Guidelines recommend using two pills from different classes of oral diabetes medications such as metformin and an insulin sensitizer.

If your A1C is below 9%, metformin is recommended alone or in combination with medication from another class, preferably an insulin sensitizer. Other classes of medication may be added or substituted, depending on your response to therapy and whether you had any side effects.

The longer you have diabetes, the more challenging it becomes to maintain optimal blood glucose management. Your treatment will need to be adjusted and intensified over time.

Blood glucose targets
• A1C: 7% or lower. (Some people with diabetes aim for 6% or lower, but this should be your target only if you and your doctor feel you can achieve it safely.)
• Blood glucose values before meals: 4 to 7 mmol/L (or 4 to 6 mmol/L if your target A1C is 6% or lower).
• Blood glucose values 2 hours after meals: 5 to 10 mmol/L (or 5 to 8 mmol/L if your target A1C is 6% or lower).

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