When do You Add More Medication?
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Monday, January 23, 2006 |
Q: "I've been on diabetes pills for about 1 1/2 months now, and have had my blood glucose numbers fall dramatically (my fasting glucose was at about 170 when I was diagnosed). In the past 2 weeks, however, I have seemed to have "bottomed out," and my fasting reading doesn't drop much below 120 (I check 1st thing in the morning when I wake up). Since I'm doing well with diet and exercise, could this be a sign that I may need more meds? How bad would my numbers have to be to put me on insulin (what I am most trying to avoid)?"
A: First of all, congratulations on your progress so far! According to the American Diabetes Association’s (ADA) Goals for Control, a fasting glucose of 120 is considered within the target goal.
It is not always perfectly clear when it is time to go to the next step, because experts can't totally agree on the glucose target goals. In case you haven’t read the answers in the archives, I will include links to answers that may help you.
A very important point: You didn't comment on your glucose results during other times of the day, nor did you mention your A1C result. It's not just the fasting glucose that matters, but also what are your glucose results before other meals, as well as 2-hours after meals, and also what is your A1C. Note however that since the A1C reflects diabetes control over the previous 2-3 months, it is possible that you might have only had a baseline A1C test and have not yet had a follow-up test.
Please review these answers that will explain target goals, along with the fact that type 2 diabetes is a progressive condition that generally requires additional medication as time goes on.
I hope the answers below will provide you with a better understanding of the whole picture. Generally, your doctor will consider many factors before deciding when to add more medication:
- Are you at your weight goal?
- Are you following a reasonable meal plan?
- Do you have regular physical activity?
- Do you have other medical conditions that could be negatively affected by poor diabetes control (such as heart disease)?
- Do you have neuropathy (nerve damage) which sometimes can be improved by achieving ideal glucose control?
- Is the A1C level over 7%?
- Are the pre-meal glucose readings often over 130, and/or the post-meal readings over 180? These are often considered "take action points" by the ADA, meaning that it is time to re-evaluate the treatment plan. Or, if your doctor is following the AACE guidelines also mentioned in the target goals link, that recommend “under 110 before meals, under 140 after meals, and an A1C under 6.5%,” then your doctor may decide it is time to either increase the dose of your medication, or perhaps add a different oral agent to your current one.
- Are the costs of your diabetes meds getting too high? Insulin actually costs less than oral agents, so sometimes people choose to start insulin sooner rather than later, especially if it becomes apparent that they will need insulin eventually.
Finally, although you are far from needing insulin (and perhaps you will never require insulin) I wish I could convince you that if you do ever need to take insulin, it is not the terrible thing that everyone thinks it is--it really doesn't hurt, and if you ever do need it, you will be glad when you get on it. You have no idea how many people I have seen over the years who physically and emotionally felt so much better after starting insulin, but who were angry that they waited so long before they moved to the next level of treatment.
Again, I don't mean to imply that you fit in this category now--but I just want to reassure you that regardless of the medication or combination of medications you might need to control your diabetes, it is well worth it to keep you healthy, energetic, and hopefully free from diabetes complications.
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Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
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