How to control type 1 diabetes?

Question

Hello doctor,

I am 58 years old and have had type 1 diabetes since my early 20s. Managing it has gotten harder, and I am now on insulin plus some oral meds like Metformin and Pioglitazone to help with insulin resistance. I also take Amlodipine and Atorvastatin for high blood pressure and cholesterol and recently started Gabapentin for nerve pain in my feet.

1. Last month’s blood work showed my HbA1c was 8.2 percent my fasting sugar is often around 150 mg/dL, and my kidney numbers (creatinine 1.5 mg/dL) and urine protein were not ideal either. I feel more tired lately, and my eyesight is sometimes getting blurry.

2. I am worried that diabetes is affecting more parts of my body and wonder if there’s something else I should be doing.

3. Are there different medications I should ask my doctor to look into? I am not sure if age is making this worse or if diabetes is just harder to control now.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

Managing long-term type 1 diabetes can become more challenging with age, as the condition can gradually affect various organs and lead to complications.

1. HbA1c of 8.2 percent and elevated fasting sugar indicate that your blood glucose is above target, and, understandably, you are concerned about the impact on your kidneys, vision, and energy levels.

2. First, it might be beneficial to reassess your insulin regimen. As insulin needs often change over time, they might need adjustments, such as a different type of long-acting insulin or more precise bolus (mealtime) dosing.

3. Insulin pumps or continuous glucose monitors (CGMs) could also help achieve tighter control by offering real-time glucose feedback and customizable insulin delivery, which could stabilize your fasting and post-meal blood sugar levels more effectively.

4. Since you are on metformin and pioglitazone to improve insulin sensitivity, it’s also worthwhile to review their efficacy at your current stage.

5. Some newer medications, like GLP-1 receptor agonists (e.g., liraglutide or semaglutide) and SGLT2 inhibitors (e.g., empagliflozin or canagliflozin), have shown benefits in lowering blood sugar, protecting kidney health, and supporting cardiovascular health in people with diabetes.

6. Monitoring and managing kidney health is essential, especially with a creatinine level of 1.5 mg/dL.

7. Regular kidney function tests, monitoring blood pressure closely, and possibly adjusting your amlodipine dose or adding an ACE inhibitor or ARB (both of which help protect kidney health) may support kidney function.

8. For your blurred vision and fatigue, checking with an ophthalmologist for any early signs of diabetic retinopathy could be helpful.

9. As for fatigue and nerve pain, balancing blood sugar more effectively can sometimes alleviate these symptoms over time.

Additionally, considering lifestyle factors like diet, exercise, and stress management along with small daily activities like stretching or walking, which can support insulin sensitivity and circulation may also boost energy and nerve health. Plan for a consultation in person or online and get a tailored treatment plan.

I hope this helps.

Thank you.