There are two interventions that I find extremely rewarding at work. The first is when I see an older patient who has been taking 10+ medications for decades, and I help them reduce it down to less than 5 with no issues. The second is when I can successfully help someone with lifestyle changes. This is especially exciting when we can follow improvements in objective measures like hemoglobin A1c, and decrease reliance on medications.
Recently I had a patient in his 30’s follow up with me for his type 2 diabetes. When he first came in over one year ago, his A1c was well over 10%1. It is unusual for someone so young to have unregulated sugar levels to this extent. We spent time reviewing his medical history, and talking about what sort of disease diabetes was and various treatment options.
He appeared engaged and open to trying something different. The patient had a family history of diabetes and was motivated to minimize medications and avoid injections at all costs. We decided to start just with the basic pill for diabetes, while in exchange he would make drastic changes to what he ate. I monitored his sugar levels closely.
In three months, we rechecked his blood tests. His A1c had returned at pre diabetic levels! The patient was ecstatic. In residency not too long ago, I had learned that diabetes was a chronic and progressive condition. Though diet and exercise can help, this condition was to be managed with lifelong medications. And because diabetes tends to worsen, meditations will only increase. I was also taught that an A1c over the 9-10% range would typically require daily insulin.
This patient has been at my clinic for over one year, and his A1c has been normal for months without taking any medications. His diet is no longer as restricted as it was when he first started.
He now knows which levers to pull if he were to ever see his sugars going up again. He can make changes as needed to lower his blood pressure should the need arise, as well as address his triglycerides, uric acid and more. He’s drastically reduced his risk of heart disease and strokes, kidney disease, neuropathy and a bunch of other conditions. And though I guided him at first, he doesn’t really need me, or any doctor, anymore for these types of chronic conditions. This makes me happy.
Hemoglobin A1c is a blood marker that estimates the average blood glucose levels.
Normal is between 5.0% - 5.6%.
Pre diabetes is between 5.7% - 6.4%
Diabetes is anything over 6.5%.
That's some good medicine!