type-2 diabetes

Goals of Treatment

The goals of treatment can be broken down into a couple of groups. Those relating to glycemic control—achieving A1c levels below 6.5 to 7% and minimizing hypoglycemia, and general or lifestyle goals that support lowering blood pressure and achieving good cholesterol levels, while encouraging a closer relationship with the patient’s healthcare provider.

Glycemic Control

A1c <7% (ADA)

A1c <6.5% (AACE)

Minimization of hypoglycemia

General/Lifestyle Goals

Healthy Diet (low saturated fat)ont>

Regular physical activity (>150 min/wk)

Blood Pressure <130/80

LDL < 100, HDL>50, TGL <150

Regular medical care & screenings

The Hemoglobin A1c test (or simply “A1c”) is used as a standard for assessing overall glucose control. This single blood test can provide an average glucose level over the previous 2-3 months, and has been correlated with the risk for microvasacular and macrovascular complications.

Percent of red blood cells with glucose bound Measures average glucose level over last 2-3 months.
6.5% - 7.0% indicates 140-150 avg glucose

Blood Glucose Targets

Blood glucose should be checked regularly to make sure that current therapies are achieving the desired results. Before meals blood glucose should be between 70 to 130 mg/dL, and 1 to 2 hours after meals less than 180.

Blood Glucose Monitoring Schedule
Monitoring blood glucose levels is important to determine the efficacy of one’s current diabetes management program. For those who do not use insulin, it is reasonable to monitor glucose levels daily, alternating test times to learn about the level of control at various times during the day.
(as applies to Non-Insulin-Using Type-2 diabetes)

Once Daily
Rotate Test Times
- Some Pre, Some Post meals
- Various mealtimes

Insulin-Using Type-2 (long-acting/basal insulin only)

For those who take long-acting/basal insulin only, it is important to monitor fasting glucose daily, as well as taking periodic readings prior to other meals, bedtime, and post-meal, as shown.

–Check twice daily, prior to meals
–Rotated test times (repeated on a 3-day cycle)
Day 1 – fasting and pre lunch
Day 2 – fasting and pre dinner
Day 3 – fasting and bedtime

–1-2 hours post-meal (each meal once/week)

Insulin-Using Type-2 (pump or multiple daily injections)

–Check at least four times daily
--Prior to all meals
--Bedtime
--Periodically 1-2 hrs post-meal