Goals for a Person with Type 2 Diabetes

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What are reasonable goals for a personwith type 2 diabetes? This is a topic that has bothered me for thelast few months. In out informal peer-to-peer group, we all havedifferent goals and most seem satisfied with their goals. Do wealways achieve our goals? Not even close to all of us achieve ourgoals every time we see our doctor, but for the most part, as a groupwe don't miss by a lot. While the average age varies every time weadd to the group, the majority are now over the age of 65. However,this does not establish goals for anyone.
The first thing I want to emphasize isthat there are no standard answers or rules. We all strive tomaintain certain limits that we can live with or tolerate. We allagree to attempt to keep our A1c's under 6.5% and lower if possible. We have all stated that we need to keep our lipid levels in range, ifpossible, but we seldom discuss this part of our lives. We have alsoagreed that our goals are ours and not for anyone else to follow. Ithappens that several of us have very similar goals and we probablytalk about this more than the rest. At present, none of us islimited cognitively and this is something we have agreed amongourselves to maintain a link to watch for any cognitive problems. Diabetes and cognition are two of the factors that have bound us moretightly as a group because we care about each other as individuals.
Even as individuals, it has beenenlightening to how we set our goals. With the current number of tenmembers and nine of us being on insulin, there is quite a bit ofsimilarity among us. Sue is still off all medications and she ishappy that we support her with her goals. She wants to keep her A1cas close to 5.5% or under if possible. Even her husband is surprisedat her success as her last A1c was 5.2%. She is the youngster in ourgroup and we do tease her about this. She replies that if the oldfogies would learn from her, we could be a lot healthier.
With the A1c range for people withoutdiabetes (normal range) according the Joslin's Diabetes Deskbookbeing from 4.0% to 6.0%, we have to remember that prediabetes isdefined from 5.7% to 6.4%. Prediabetes is another topic that manywish would be labeled as diabetes. Because A1c values do varyquarterly, some are advocating that we should check the A1c valuesmonthly. For more information on this, please read this blog byDavid Mendosa.
With this in mind, here are some goalsfor people to look at as possible goals they should consider as theirown. Therefore, select realistic goals and work toward them.  Of the nine members on insulin, ourA1cs range from 5.5% to 6.5%. as of the latest A1c values. Some ofus have the same A1c and don't get too concerned since this should beexpected. Max and I are the only two that occasionally exceed 6.5%and then we have to work very diligently to make sure we get below6.5% on the next A1c.
We are all careful to avoidhypoglycemia and three of the individuals have never hadhypoglycemia. Since I have been on insulin the longest, by about twoyears, I have had the most incidents of this, but never one that Iwas not aware of or prepared to correct. On several occasions, Iknew as soon as I put down the syringe that I was going to need to beaware of and prevent this from happening. On two occasions, Iaccidentally injected my short-term insulin in the same area as thelong-term injection. I stayed up late both nights and fortunatelyhad enough test strips and glucose tablets to stay out of trouble andonly get to the lower 60's for blood glucose levels.
I have had eight readings below 65mg/dl in the nine years on insulin and the next is only five readingsbelow 65. Then the numbers go to three and two. Why do we choose 65for our hypoglycemia? Because we can and in general we do not getbelow 70 mg/dl. Several of the group try to constantly remain under125 mg/dl and above 80 mg/dl and have been very successful at it.
We are all fortunate to have the teststrips we need or be able to afford more if insurance limits us. Five of us do obtain our diabetes supplies and medications from theveteran’s administration (VA) and are thankful for that. Ourtesting supplies are very much what we need and we make use of them.
We are now over a month into 2013 andhave now added three additional members that are very happy to haveus helping them. Brenda and Joy are probably the most pleased, astwo of them are women and are happy to have others to talk with. Allthree are presently on oral medications, which is also revealing. Inour first meeting, with three of the group absent for work, the onesnew to the group were very curious as to why so many of us were oninsulin. Brenda was happy to say “Greater ease of management.” This of course became our discussion for that meeting. The A1cs forthe new members was 6.6% to 7.0% and they were surprised at our A1csof all being 6.5% or less. Many questions were answered about multipledaily injections and testing. The three were surprised at ourrelaxed attitude about this and that fact that most of us did notthink anything about the extra testing and multiple injections.
They were all surprised that we usedour arms and different parts of our bodies for injecting insulin. They were very interested in why and Brenda was happy to answer thatwe needed to prevent insulin absorption and utilization problems andavoid creating scar tissue under our skin. This in turn would affectthe insulin utilization and cause insulin waste if scar tissue causedthe insulin not to disperse from the injection site. Some mayescape, but not the full amount injected.
Then the question was asked aboutalternate site testing. We all stated that we used our fingers andnot alternate sites because we wanted the “now” reading foraccurate correction data and needed to know this. If we were goingup or down was also mentioned. Then Tim said that for those on oralmedications other than sulfonylureas, alternate site testing wouldwork if their readings were fairly consistent. Brenda advised themto be careful if their readings were still fluctuating up and downsince they were new to testing. Two were on metformin and one on asulfonylurea and metformin. All three said their doctors had advisedthem against alternate site testing for now, but that they were happythat we were willing to talk about this.
Allen then said that they would all bewise to read about and understand insulin, but there was no hurrysince so many of us were on insulin. Then he asked how long each hadbeen on metformin. The answer was one year and the other two foronly six and eight months. The two women asked if he was concernedabout vitamin B12 and when Allen said yes and vitamin D, they saidthat the diabetes clinic had tested both of them for these and saidboth had been advised to add them as supplements. The fellow said hehad also been tested. Then one of the women said they understood hisconcern after what had happened to him and he said then you have beenreading Bob's blog. All three admitted they were and Allen said atleast we are all on the same page.
Then we needed to call an end to themeeting and the three of them wanted to ask more questions. Weallowed one question and they agreed. The fellow asked why I was theonly one blogging. I could see the eyes looking at me, so I spokeup. I said most are not ready and they do not have the desire that Ihave. Ben then said, he agreed as he had thought about it, but eventhough he enjoyed the research, he was not ready to write even once aweek. He said that he does send me blog ideas and I agreed and saidseveral others do as well. Brenda said she has no desire, but enjoysmost of what I write about, but not everything. She also said thatthey appreciated that I did not use their real names and had agreedthat I could use a made up name to keep people identified.
Since people were anxious to leave, Itold the three, that if they had any interest, to please contact meand I would tell them what I could. Two have and are especiallylooking for other resources and a few other bloggers to read. Theone has been reading from the blogger list I maintain and I have sentboth other bloggers from the type 1 bloggers and others.