DEAR DR. ROACH: I’m a 70-year-old woman. I have Type 2 diabetes, and my morning fasting blood sugar numbers are all over the place. It’s very frustrating. I take glipizide and metformin. Could you tell me how to correct the numbers? — L.C. ANSWER: Unfortunately, I can’t give you specific advice without a whole lot more information, but I hope some general advice will be helpful.
First, I’m not sure what you mean by “all over the place.” Fasting blood sugars in a person with diabetes are ideal when they are between 70-130 (or so) mg/dL, which is a broad range. If you are having consistently lower numbers, this might indicate that you are taking more medication than you need. A hemoglobin A1C level will help determine your overall control and is an essential first step.
High morning blood sugar levels can mean inadequate blood sugar control, but it can also mean a reaction to early morning hypoglycemia (having too low blood sugar). The use of continuous glucose monitors is making a dramatic change in the way we monitor blood sugar and adjust medication, although insurance often pays for it only when a person with Type 2 diabetes is on insulin and has low blood sugar.
Glipizide is no longer a first-line treatment for Type 2 diabetes, especially in older adults, as there is a higher risk for low blood sugar with this medicine than with most others. Sometimes a person does really well with it, but most of the time, newer alternatives provide better blood sugar control with less risk of low blood sugar. They also provide more of a benefit to your heart and blood vessels.
Lifestyle changes remain the most critical intervention for Type 2 diabetes, and you can get lots of help from a diabetes educator and a registered dietician. Many times, improving diet and exercise allows a person to stop some, or occasionally all, of their diabetes medicines.
