People with type 2 diabetes often find visits with their physicians frustrating. Dr. Jeffrey Mechanick, MD, FACE, FACP, Secretary of the American Association of Clinical Endocrinologists (AACE), observes, "Many times when patients come to the doctor, the first thing that they say is really what's on their mind--that's their top priority. But oftentimes physicians don't address that at all. Instead, they move on to what's on their own agenda."
Victoza, a drug aimed at type 2 diabetes, may turn out to be a boon for type 1 diabetes patients as well. A small clinical study shows that patients with well-controlled type 1 who took Victoza daily for just one week experienced a 15 percent drop in their blood sugar levels. Patients who took the drug over a full 24-week test period needed less and less insulin, decreasing their average mealtime dose by seven units and their all-day insulin requirement by eight.
Over the last decade, dramatic changes have occurred in our understanding of the onset and progression of prediabetes. Lightning speed changes have also occurred regarding the therapies available to achieve optimal blood glucose control. Even with all of this change, however, many old dogmas hang on. It's time to become aware of the new realities. In this article, I focus on two common old dogmas and the new realities.
A few months ago, I had the privilege of traveling to Australia to present at a conference of athletes with diabetes. During the meeting, prizes were awarded to everyone who scored exactly 5.5 mmol/L (99 mg/dL) on their glucose meter. You should have seen it! Anyone who measured close to 5.5 was testing again and again, hoping for that magic number to pop up. Fingers were suffering, but the test strip manufacturers were making out like bandits.
Meet Mary,* a 16-year-old girl with type 1 diabetes. When her parents ask her how her blood sugar is, she always has a good number. She keeps a tidy logbook of her blood sugars, and they look fine, although her last A1C was inexplicably high. It's been a long time since she was diagnosed, and her parents are confident that she knows how to care for herself. She has been somewhat less energetic for quite awhile, but her parents attribute that to growing pains, as Mary has grown from a chubby child into a very slender young woman. She appears a little dehydrated and flushed sometimes, but she always drinks a lot of water and goes to the bathroom frequently, so her parents aren't concerned. They have also noted a fruity odor about her, which she attributes to a new lip gloss.
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