From Advance, North Carolina, USA:
I have had insulin dependent diabetes for 38 years (now 60 years old), but have only mild neuropathy in my feet as a symptom. I commonly run A1cs in the 8 or even low 9 range, although I am capable of lower values in the sevens (e.g. 7.6). My current primary care physician wants to get me lower with more aggressive insulin applications. He cites the latest studies on the predicted increase in vascular problems for even slight increases in A1c values. Several years ago, I had a serious hypoglycemic event in which an ambulance was needed.
Can you tell me where the actual data on increasing risk with increased A1c values can be found (DCCT study)? Also, after this long without serious side-effects, would you recommend aggressive control to lower the A1c into the non-diabetic range? Is it worth the potentially life-threatening risk of another hypoglycemic event?
I agree that when you begin to go below 8.0% for an A1c, the frequency of hypoglycemia becomes more frequent. However, this is not a reason not to try to reach a goal of less than 7%. It means you take a conservative approach with increased safeguards to try and prevent hypoglycemia. Interval decreases in A1c may not be as large as previous changes. Certainly, there is good data in The DCCT for primary and secondary prevention of microvascular complications (neuropathy, nephropathy, and retinopathy). There is also data about vascular disease, especially with vascular calcifications, where higher A1cs are associated with more calcifications and more disease.
I would recommend you speak to your physician about a strategy you can feel comfortable with. Frequent monitoring is a must. Interval reporting is also required. Make sure you carry glucose with you at all times and have glucagon at home so that if you do lose consciousness, someone can revive you with this injection. The DCCT also showed that hypoglycemic episodes were three-fold greater in the more intensively treated group. However, with care, I think you can make gradual changes. Stopping at 7.6% is also not warranted.
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