Do not treat blood sugar intensively

Do not treat blood sugar intensively
Is “lower is better” the right approach when treating high blood sugar in someone with diabetes?


In a recent column you said that doctors are not trying to lower blood sugar as much as they used to in people with diabetes. My husband’s doctor always tells him that “lower is better” when it comes to his blood sugar. Can you explain?


When I was in medical school, and for many years thereafter, “lower is better” was what doctors believed. We knew that people with diabetes could develop severe, even fatal, complications if their blood sugar got very high. Plus, we had powerful blood-sugar-lowering treatments available.

On the other hand, there was a limit to “lower is better.” Too much of a good thing could be a bad thing:
Overtreatment could push blood sugars too low — dangerously low. Sustained very low blood sugar can produce confusion, coma and death. So we measured blood sugars frequently, with the goal of having blood sugar as low as it could go without causing bothersome symptoms.

That was the goal because studies many years ago had shown that such “intensive treatment” reduced some types of complications of diabetes. Doctors speak of two types of complications of diabetes, both involving blood vessels.
The first is disease of small blood vessels (called microvascular complications), which affects the eyes, kidneys and nerves.
The second is disease of the large blood vessels (called macrovascular complications), which causes heart disease, strokes and peripheral artery disease.
An analysis of the strongest type of studies, randomized trials, involving nearly 35,000 people with diabetes, found that intensive treatment had a benefit: It led to a more than 10 percent reduction in small blood vessel complications.
I assumed, as did most doctors I know, that if intensive treatment lowered small blood vessel complications, then it would also lower large blood vessel complications. However, over the past 40 years, the evidence on that score has been quite mixed.

Many studies show that people with higher blood sugars are more likely to have large blood vessel complications, such as heart attacks and strokes. So you might think that intensive lowering of blood sugar would reduce the rates of large blood vessel complications. But that’s not necessarily true.

The way to see if it is true is through large, randomized trials. In these studies, some people with diabetes (chosen at random) were given intensive treatment that kept their blood sugars very low. Others were treated less intensively and had higher blood sugars. These studies all have abbreviated names. The best known are VADT, ACCORD and ADVANCE.

Unfortunately, these trials did not demonstrate a benefit from intensive treatment compared to less intensive treatment. And more patients in the intensive treatment group have suffered from the complications of blood sugar that is too low. Worst of all, in one of the studies (ACCORD), the rates of premature death from heart disease and from all causes were actually higher in the intensive treatment group.
Too much of a good thing might have been fatal. One possible reason is that the low blood sugar may have triggered a dangerous heart rhythm.

So, while lowering blood sugar with treatment definitely improves health, there are limits. Today I and many other doctors do not treat blood sugar as intensively as we used to. more  

View all 19 comments Below 19 comments
Thanks Dr Raja I will discuss the issue with endocrinologist. more  
Sunil Gupta, You should be in consult with an Endocrinologist. The Recommended figures are: Normal blood glucose numbers Fasting Normal for person without diabetes: 70–99 mg/dl (3.9–5.5 mmol/L) Official ADA recommendation for someone with diabetes: 80–130 mg/dl (4.5–7.2 mmol/L) 2 hours after meals Normal for person without diabetes: Less than 140 mg/dl (7.8 mmol/L) Official ADA recommendation for someone with diabetes: Less than 180 mg/dl (10.0 mmol/L) HbA1c Normal for person without diabetes: Less than 5.7% Official ADA recommendation for someone with diabetes: 7.0% or less more  
Thanks Dr Raja for very informative article. I am 69 Diabetic Type II CKD IIIa . My HbA1c varies between 5.5 to 6. I am taking Amaryl 2mg in the morning, Trajenta 5 mg one hour before dinner and Amaryl 1 mg with dinner for diabetes. With this medicine my fasting sugar remains below 110. If I reduce my evening dose of Amaryl to 0.5 mg, my fasting sugar is in the range of 114 to 125. Can you please suggest whether I continue with Amaryl 1mg or I can reduce it to 0.5 mg. Thanks more  
Informative more  
Mr. Chandan Pal - it is surprising - this type of problem I am having last 10 years. And I was not on any medicine. Only after angioplast I am on Starvas 40 mg. But still my case is same. FBS is always higher but PPBS well under control. Only now I make sure to eat some thing every 3 / 4 hrs. more  
Post a Comment

Related Posts

    • Blood vessels, plaque

      Daiabetic for 20 yrs,lipid profile test result showed within limits. Hips area &calf muscles paining,diagnosis-plaque formation in blood vessels,but no block, prescribed Cilostazol 50 mg X...

      By Haridas P V
    • Retinopathy . In

      74 yrs,M, diabetic,20 yrs,taking medicines, retinopathy initial stage,adivce pl

      By Haridas P V
    • Diabetes management from a Doctor friend

      If you have diabetes or have a family member who has diabetes, please remember and remind them to take very good care of the feet. A LOT of complications can be prevented if all diabetics are educa...

      By Vinita Agrawal
    • Diabetes Control

      Do read everyone

      By Vinita Agrawal
    • Managing Diabetes Successfully

      Diabetes: it is slow, silent and stealthy. It can come on progressively and affect almost every part of your body. It can be perilous, precisely because it is so gradual and we are often so unaware...

      By Ruchika L Maheshwari
    • Manage diabetes with guava

      1. Guava has a low glycaemic index (GI), meaning it is digested and absorbed gradually and affects a gradual rise in glucose level. 2. Being highly rich in fibre, which is considered gre...

      By Asha Gupta
    • Mango and Diabetes

      How much can you eat and when...Watch everyone please and share your experience.

      By Vinita Agrawal
    • Diabetic pain in legs

      Can anyone suggest remedies for leg pain in diabetic patients with long standing.In addition to maintaining good control ove sugar, what other precautions should one take? Any method to improve blo...

      By Narindar Sharma
    • diabetic friendly fruits

      1. Papita (Papaya) Papita or papaya is a desi fruit that has a number of benefits for us. India is one of the biggest producers and exporters of papaya worldwide. The tropical fruit has a low ...

      By Aditi Jain
    • Suggestion for Allopathic Doctor

      Please suggest a good doctor for treatment of Fatty lever and Cholestrol in Gurgaon / Delhi. Thanks

    • Dont eat sabudana

      Diabetic people please dont do vrat during durga pooja and definitely dont eat sabudana if you keep vrat.

      By Anu Kaur
Enter your email and mobile number and we will send you the instructions

Note - The email can sometime gets delivered to the spam folder, so the instruction will be send to your mobile as well

All My Circles
Invite to
(Maximum 500 email ids allowed.)