Type 2 diabetics can now have more sugar in their blood but not diet

Type 2 diabetics can now relax a little – but just a little – about their blood sugar levels, according to newly-released guidelines from the American College of Physicians.

The association has rolled back its recommended blood sugar levels today, suggesting doctors consider lowering medication dosages if their patients are reaching the old targets.

Updated guidelines also advise that for some patients, like the elderly, strict blood sugar control may not return enough benefits to be worthwhile. 

The new guidelines suggest that type 2 diabetics aim to have blood sugar levels between seven and eight percent as measured by the A1C blood test, rather than between 6.5 and seven.

The American College of Physicians has relaxed target blood sugar levels for type 2 diabetics

According to the Centers for Disease Control and Prevention, more than 100 million people in the US have either diabetes or pre-diabetes.

Last week, researchers in Sweden and Finland published a new report suggesting that type 2 diabetes should actually be broken down into five separate types, in the hopes of better tailoring treatments to individuals suffering the disease.

The pancreases of diabetics do not properly process sugar, either because their bodies do not produce enough insulin (in type 1) or because they have too high of an insulin tolerance (in the set of variations formerly called type 2).

Maintaining a diet low in sugar helps people with type 2 diabetes to avoid unpleasant symptoms like excessive hunger and fatigue and lowering their risks of developing potentially fatal complications like heart disease and Alzheimer’s.

In order to make sure their blood sugar is under control, diabetics’ average blood sugar levels over the past three months, they take regular A1C blood tests.

Until now, the American College of Physicians had recommended that people with type 2 diabetes maintain blood sugar levels between 6.5 and seven percent, as measured by the test.

According to the National Institutes of Health (NIH), a normal, non-diabetic person’s A1C level is below 5.7 percent, and a diabetic’s is anywhere above 6.5 percent.

WHAT ARE THE FIVE NEW TYPES OF DIABETES?

For decades the disease has been considered to be two different forms – type one, an autoimmune disease in which people stop producing insulin, and type two, in which the body becomes resistant to insulin.

But now a major project in Sweden and Finland has found type two diabetes should actually be categorised as four different diseases.

The researchers, led by experts at Lund University, said the findings should prompt a ‘paradigm shift’ in the way people treat diabetes.

Cluster 1. Severe Autoimmune Diabetes – which until now has been known as ‘type one’ diabetes – is an autoimmune disease in which people stop producing insulin. Usually strikes in childhood but can emerge in adults. Requires insulin injections for life.

Cluster 2. Severe Insulin-Deficient Diabetes – young people often misdiagnosed as having type one, but whose immune systems are fine. Actually a variant of type two diabetes, but often of a healthy weight. High blood sugar, low insulin production and moderate insulin resistance.

Cluster 3. Severe Insulin-Resistant Diabetes – is predominantly linked to obesity and severe insulin resistance.

Cluster 4. Mild Obesity-Related Diabetes – includes obese patients, but is less serious and includes people who fall ill at a relatively young age.

Cluster 5. Mild Age-Related Diabetes is the largest group, with 40 per cent of all patients, and consists mostly of elderly patients.

People with blood glucose levels between 5.7 and 6.4 percent are considered pre-diabetic, meaning they are on the verge of developing an irreversible insulin resistance. 

But recent research has revealed that hitting a target blood sugar level between 6.5 and seven percent may actually do more harm than good to some patients. 

Several studies linked these levels to higher risks of heart disease, hypoglycemia – a condition where blood sugar gets too low – and even death. 

‘When blood sugar becomes too low, the heart starts to race and all sorts of regulatory hormones – like adrenaline – are poured out,’ says Dr Jack Ende, President of the American College of Physicians (ACP). 

‘For patients like the elderly, those events can cause heart attacks or death,’ he says.   

Hypoglycemia can also lead to blurred vision and weakness, making falls and car crashes more likely and significantly increasing the risks of death for older people.

Dr Ende emphasizes that the ACP ‘does not condone walking around with uncontrolled blood sugar,’ but rather wants diabetics and their doctors to continue to focus on keeping blood pressure and cholesterol low through exercise and quitting smoking. 

‘There may be more benefit there than with the hyper-focus on [blood sugar] levels,’ he says.  

‘We didn’t want to stand around and do nothing when there are studies indicating that there are harms for having too tight control’ on blood sugar levels, he adds. 

The take home message is not that patients should now eat more sugar, but rather that they should be less medicated if they are reaching target glucose levels.  

The ACP also wants to be realistic about the patients for whom there may be higher health and quality of life priorities. 

Research has shown that control over blood glucose does have benefits, but they become most apparent as much as 17 years in the future.  

‘It is inappropriate to have someone with limited life expectancy and have intense control [over blood sugar] if there’s only a benefit in years and years,’ says Dr Ende. 

‘We like to practice sensible medicine and be sure that whatever we’re asking patients to do really in in their best interest, and this seems to be the case with the treatment of type 2 diabetes,’ he says.  

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