Beyond the Prescription: A Real-World Guide to Managing Diabetes
Patricia came to see me for the first time after being diagnosed with diabetes. She had a history of gestational diabetes during three of her four pregnancies, each time requiring insulin treatment. After delivery, her blood sugars always returned to normal—until years later, when routine bloodwork revealed that her hemoglobin A1c had risen into the diabetic range. Her primary care physician prescribed metformin and sent her on her way.
Patricia took her medication faithfully, even as she developed persistent diarrhea and unintentional weight loss. For more than a year, she endured these symptoms before discovering that they were likely side effects of metformin. Within days of stopping the medication, her digestive issues resolved. That’s when she realized she needed a crash course on how to truly live with diabetes—beyond just taking a pill.
Understanding Diabetes
Diabetes is a chronic condition that occurs when the blood carries too much sugar aka glucose.
There are two main types of diabetes:
Type 1 diabetes – Caused by destruction of the pancreas’ insulin–producing beta cells, leading to insulin deficiency.
Type 2 diabetes – Results from insulin resistance, where the body’s cells no longer respond properly to insulin, requiring higher levels for glucose control.
Despite their different causes, both forms share similar management principles: maintaining healthy glucose levels through a combination of lifestyle changes, monitoring, and sometimes medication.
Glucose Targets
The hemoglobin A1c (HbA1c) test measures average blood glucose over the past two to three months. Originally developed for monitoring, it is now also used to diagnose diabetes. Landmark studies—the Diabetes Control and Complications Trial (DCCT) and the UK Prospective Diabetes Study (UKPDS)—showed that maintaining an A1c under 7% significantly reduces the risk of diabetes-related complications.
For most adults with diabetes, the target A1c is ≤7%.
In addition to A1c testing, fingerstick glucose checks provide real-time feedback and help guide food and medication choices:
Fasting or pre-meal glucose: 80–130 mg/dL
Two hours after meals: ≤180 mg/dL
An increasingly popular option is continuous glucose monitoring (CGM), which tracks glucose levels in real time through interstitial fluid. The Time in Range (TIR) metric from CGM data is another way to assess control: spending more than 70% of the time between 70–180 mg/dL typically corresponds to an A1c below 7%.
Lifestyle Modifications
Lifestyle changes are the cornerstone of diabetes prevention and management.
The Diabetes Prevention Program (DPP) demonstrated that “intensive lifestyle intervention” is the most effective way to prevent the progression from prediabetes to diabetes.
Every person with glucose intolerance or diabetes should meet with a certified diabetes educator and/or registered dietitian to design a personalized plan for nutrition and physical activity.
While there is no “one-size-fits-all” approach, these professionals can help you create a realistic and sustainable plan to optimize your blood sugar, energy, and overall health.
Complications and Screening
Diabetes can affect both small and large blood vessels, leading to:
Microvascular complications:
Eye disease (retinopathy)
Kidney disease (nephropathy)
Nerve damage (neuropathy)
Recommended screening: annual eye and foot exams and periodic urine protein testing.
Macrovascular complications:
Heart attacks
Strokes
Prevention: control blood pressure and cholesterol through regular monitoring, lab testing, and appropriate treatment.
Patricia’s Plan
Patricia left my office wearing a continuous glucose monitor to help her track her sugars according to the targets we discussed. SI referred her to an ophthalmologist and podiatrist for screening and sent her to our dietitian to refine her lifestyle plan. I also ordered lab tests—including hemoglobin A1c, urine protein, and cholesterol levels—to better understand her current health status.
By the end of her visit, Patricia had the tools, knowledge, and confidence to take control of her diabetes—and to live not just with the disease, but well in spite of it.