Glucose Balance is Crucial for Diabetics

LEXINGTON, Ky. (Nov. 27, 2012) - The following column appeared in the Lexington Herald-Leader on Sunday, Nov. 25.

By Dr. Philip Kern

Should everyone diagnosed with diabetes strive to have the lowest possible blood sugar? Not in every case.

New research suggests that in some individuals, the medications and treatments required to lower blood sugar to “optimal” levels may actually do more harm than good.

Approximately 26 million Americans have diabetes. Another 79 million are pre-diabetic — meaning they have abnormal glucose intolerance. Those with pre-diabetes are at serious risk of developing type 2 diabetes — the most common form of the disease. <?xml:namespace prefix = owc />

Diabetes involves an elevation in blood sugar (glucose).

One reliable way to follow the overall “average” blood glucose is with a hemoglobin A1C level, which in normal healthy individuals is between 4.5 and 6 percent.

People with diabetes are at a higher risk of other health problems including blindness, kidney disease, heart disease, nerve damage and amputations.

Since high blood glucose is the cause of these health issues, it would seem logical that everyone with diabetes should strive to have blood sugar in a normal range, right?

The truth is that while some individuals with diabetes should strive for blood glucose values that are as close to normal as possible, for others “perfect” blood glucose may be difficult to achieve without causing additional health complications.

A study called Action to Control Cardiovascular Risk in Diabetes looked at the effect that aggressively lowering a patient’s A1C could have on their health. The study used over 10,000 individuals with diabetes in their research.

When medications and insulin were used aggressively to get A1C down to less than 6, the risk of death went up, not down.

This phenomenon can perhaps be explained by the fact that aggressively lowering glucose may make patients hypoglycemic, leading to risks of blackout or adrenaline rushes that may be stressful to the heart.

Children with diabetes are particularly vulnerable to medication-induced hypoglycemia.

Children are more likely to have Type 1 (“Juvenile”) diabetes, although the rate of Type 2 diabetes among children is presently rising.

People with Type 1 diabetes generally have to take insulin for life. It is very important to educate the child and the family, facilitate good communication between the patient, their family and health care providers, carefully monitor blood glucose and use all available tools to adjust the insulin dose to regulate glucose while avoiding hypoglycemia.

It is crucial that individuals with diabetes work closely with their health care providers to achieve balance in their glucose and overall health.

Even if glucose remains higher in the person with diabetes than it would be in a non-diabetic person, each case should be evaluated on an individual basis to determine exactly how low glucose can be pushed via medication and treatment, without triggering dangerous hypoglycemic reactions.

Dr. Philip Kern is the director of the Barnstable Brown Kentucky Diabetes and Obesity Center at the University of Kentucky.