Sugar, diabetes encompassed

Dear Dr. Roach: I am 74 years old and have been a brittle Type 1 diabetic for 50 years. I have no history of heart disease. My doctor of 40 years recently retired and had me control my hemoglobin A1C to a range of 5.9-6.2. My new doctor, who is in her mid-30s, wants me to elevate my hemoglobin A1C to 8.0. Is this the new way of controlling blood sugar? — E.S.

“Brittle” diabetes is when it is hard to control too-high and too-low blood sugars.

The A1C is a blood test that looks at average blood sugar over the past few months. A normal A1C is between 4 and 5.6%. People with normal A1C levels are at very low risk of complications from diabetes.

On the other hand, low A1C levels put people at higher risk for low blood sugar, which can be very dangerous. People with Type 2 diabetes and blockages in blood vessels were shown to have higher risk of heart attack. For this reason, recent guidelines for older adults with Type 2 diabetes have had more relaxed goals. For Type 1 diabetes, most guidelines still recommend an A1C goal of less than 7%. However, for a person with Type 1 diabetes who also has other medical problems that are likely to impact mortality, and for those at high risk for severe hypoglycemia, a more relaxed goal is not unreasonable.

Hypoglycemia is a big problem in people with brittle diabetes.

A lower A1C is associated with a lower risk of damage to small blood vessels. If you have been able to keep your A1C in the range of 5.9 to 6.2, and have not had any serious episodes of low blood sugar recently, I would wonder why your new doctor feels your blood sugar needs to be substantially higher than it is.

Finding the right balance between good control and freedom from hypoglycemia isn’t always easy, but these are the risks and benefits your doctors have been considering.