Q: I was diagnosed with type 2 diabetes about six years ago. In the beginning, I controlled my diabetes with diet and exercise. But last year I started taking glyburide and extended-release metformin. My fasting blood glucose is 150 -- 180 mg/dl, and my last A1C was 7.0 percent. I have to admit that currently I'm not exercising. What do you suggest?
A: Right now, your A1C is close to target, but seek the advice of your doctor to see if you should aim for a reduction in your A1C. The American Diabetes Association (ADA) recommends an A1C of below 7 percent and as near to normal (below 6 percent) as possible without running too low. The ADA's target fasting blood glucose range is 70 -- 130 mg/dl.
Think of diabetes self-management as a stool with three legs: physical activity, healthful eating, and medications. If you shorten or remove any one of the three legs, the stool won't be level or might even fall over. Your glucose monitor (and periodic A1C test results) sits on top of the stool, reflecting the balance of the three legs.
Your doctor's role in keeping the diabetes-management stool level is to regularly evaluate your overall situation and make medication adjustments to help you achieve your targets. The glyburide you take helps the pancreas make more insulin. Metformin helps the liver release more normal amounts of glucose to regulate fasting blood glucose levels. To a degree, the metformin also helps increase sensitivity to insulin.
The stool's other two legs -- what you eat and how you include movement in your day -- are areas you can choose to improve. A certified diabetes educator (CDE) or diabetes education classes can help you make changes that fit your lifestyle.
Virginia Zamudio Lange, R.N., M.S.N., CDE, is a registered nurse, certified diabetes educator, and a past president of the American Association of Diabetes Educators.