Saturday , November 18 2017
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The Power of Numbers

A disaster can be considered many different things to different people. For some it could mean developing type 2 diabetes rather than preventing or delaying it.

If you watch our expert video series you will hear our Publisher ask many of our experts, “Whether or not you have diabetes, what would you like your A1C to be?” As our expert, Dr. Karl Nadolsky said, he’d like his to be in the normal range, ~ 5%. This is not unusual for us as health care providers to want and work towards a normal A1C, that is, depending on age, and risk for complications of hypoglycemia.
Woman, prediabetes, A1C 5.8%, HO obesity, breast cancer, gestational diabetes. FH-Mother had type 2 diabetes and obesity. Patient is taking 1,000mg twice daily of metformin (off label because no medication has yet been approved for prediabetes). She visited her PCP who told her her glucose is normal-she need not be concerned. She asked me if she should stop her metformin. I reviewed and sent her the diagnostic criteria for prediabetes and diabetes, as well informed her that metformin, along with a healthy lifestyle (she is following a low glycemic meal plan with regular exercise including strength training) has shown to help her weight, decrease her risk for diabetes and possibly reoccurrence of breast cancer, but since it’s off label that’s up to her. I also informed her that I think if she weren’t taking the metformin, I would not be surprised if her glucose levels would be in the diabetes range. She did her homework-read what I sent her and decided to stay on the metformin. We’ve also since discussed using another medication to help lower her glucose without causing weight gain or hypoglycemia to help her A1C get into a normal range.
Lessons Learned:
  • Always teach numbers- the power of numbers and what they mean. What are the diagnostic criteria for normal, prediabetes and diabetes ranges.
  • Teach and remind patients of the power of a healthy lifestyle. This can mean different things to different people. There is on perfect “diet” for everyone. Science has shown us the best “diet” for someone to follow is the one that they can stick to. This does not mean junk food. As for physical activity, the ADA standards of care even recommends to increase moderate activity to at least 150 minutes/week. Remember some activity is better than none and do add resistance training.
  • Teach that yes, some medications are used off label for prediabetes. If you use this in your practice, teach patients why and warn them other health care providers may not agree.
  • Ask your self-what would you like your levels to be? Why not give your patient that option to choose what they want and are willing to work for?
  • The more informed your patients are-the better your patients can choose what they want to do for their health. The decision is then a decision made together with information or shared decision making.
Joy Pape, FNP-C, CDE
Medical Editor, DiabetesInControl

 

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