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Why Lucky #7 Isn't Enough for Diabetic Management

continuous-glucose-monitor

Last month I posted a blog explaining how important the number 7 is to a diabetic when it comes to their A1C measurement. The A1C measurement reflects the average blood sugar levels in a diabetic for the last 90 days. Keeping that level low is indicative of good control but it does not tell the whole story.

(Warning Alert: Whenever a doctor starts telling you the whole story you are about to get numbers and abbreviations up the wazoo! Sorry about that but it can’t be helped…..)

Someone without diabetes has a blood sugar level that varies slightly during the day, depending on eating habits—up after eating and lower when they get hungry. However, diabetics have higher highs and lower lows during the course of the day. These larger variations ultimately lead to health complications which account for 1 in 4 of all health dollars spent in the US. A patient can have an A1C of 7 and have unhealthy high levels of blood sugar 58% of the day, too low for 18% of the day, and be in the normal range for only 24% of the day. This is obviously very different than a non-diabetic having a 100% normal range throughout the day.

The key to good diabetic management is to constantly monitor the patient’s blood sugar levels and administer insulin whenever the levels get too high and back off the insulin when they get too low. This concept is called Time In Range (TIR).

Currently 30% of all diabetics in the US (compared to only 1-2% worldwide) are using Continuous Glucose Monitors (CGMs), which have implantable sensors that are constantly assessing the patient’s blood sugar. This gives the doctor a detailed report of the number of hours the diabetic is in a safe blood sugar zone and when they are either too high or too low. This allows for the patient’s treatment to be fine-tuned to increase their TIR. If by doing these fine-tunes the patient can increase their TIR by 10%, they decrease their chances of getting diabetic retinopathy by 61%!

Ideally as we see more and more diabetics receiving CGMs from their doctors, we will see a dramatic decrease in blindness due to diabetes. If your doctor has provided you with a CGM, then do what you can to maximize your TIR. If you do not have a CGM then talk to your doctor about getting one and try to maintain an A1C of 7 until you do so. Your sight may very well depend on it!

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Thursday, 14 November 2019