Conflicting Diabetes Advice: Who Should You Trust for Your Health?

I'm not sure whose advice to follow?

Previously, I visited a nearby major hospital's endocrinology department due to thyroid issues.
The doctor conducted blood tests and a urinalysis, and while my thyroid function was normal, my hemoglobin A1c was 6.5%.
However, my fasting blood glucose was within the normal range (88 mg/dL), my creatinine level was 0.8 mg/dL, and my glomerular filtration rate was 84.9.
The doctor advised me that only my hemoglobin A1c was elevated and instructed me to be cautious, manage my diet, and exercise, with a follow-up appointment in two months.
After reviewing the report at home, a friend recommended a newly opened diabetes clinic.
I went there, and they conducted another blood test.
A week later, when I reviewed the results, the doctor prescribed Glimepiride for me.
During my next visit, the report showed my hemoglobin A1c had increased to 6.6%.
I was confused because if this value reflects the average over the past three months, how could it change so quickly in just one week? My fasting blood glucose and postprandial glucose were both normal, and all other indices were consistent with the major hospital's tests.
The clinic doctor diagnosed me with diabetes and instructed me to take the blood sugar-lowering medication (Glimepiride).
He mentioned that the medication would only "maintain" my hemoglobin A1c level without reducing it, and that it would be impossible to lower it through diet and exercise alone.
He also warned that if I didn't take medication, my kidney function would deteriorate within ten years, leading to the need for dialysis.
One doctor said diet and exercise could help, while another insisted that medication was the only viable option.
I'm unsure whom to believe.

Lisa, 30~39 year old female. Ask Date: 2023/11/28

Dr. Liu Hongxiang reply Family Medicine

Hello Lisa,
Glycated hemoglobin (HbA1c) is formed by the binding of glucose to hemoglobin in the blood.
The average lifespan of red blood cells is 120 days, so glycated hemoglobin reflects the average blood glucose levels over the past three months.
Daily fluctuations in blood glucose can affect the HbA1c levels.
If there is an increase in HbA1c, it indicates periods of hyperglycemia.
Conversely, if blood glucose levels can be controlled and reduced, HbA1c will also decrease.
An HbA1c level of 6.5 is considered elevated, which requires dietary changes, exercise, and weight management.
Medications can help achieve better blood glucose control; starting with metformin may be a good option, and adjustments can be made based on future blood glucose changes.

Wishing you good health and well-being,
Dr.
Liu Hongxiang

Reply Date: 2023/11/28

More Info

Navigating conflicting medical advice, especially regarding diabetes management, can be incredibly confusing and stressful. It’s essential to understand that different healthcare providers may have varying approaches based on their experiences, philosophies, and the specific circumstances of each patient. In your case, you received two different perspectives regarding your glycosylated hemoglobin (HbA1c) levels and the management of your blood sugar.

Firstly, let’s clarify what HbA1c means. HbA1c is a measure of your average blood glucose levels over the past two to three months. An HbA1c of 6.5% or higher is generally considered indicative of diabetes, while levels between 5.7% and 6.4% are classified as prediabetes. Your initial reading of 6.5% suggests that you are at the threshold of diabetes, which is why the first doctor advised you to monitor your diet and exercise closely. The normal fasting blood glucose level you mentioned (88 mg/dL) is indeed within the healthy range, which is a positive sign.

The second doctor’s advice to start medication immediately, despite your normal fasting and postprandial blood glucose levels, raises some questions. It’s important to note that while medication can be necessary for some individuals with diabetes, lifestyle changes such as diet and exercise are also critical components of diabetes management. In fact, many studies have shown that lifestyle modifications can significantly improve blood sugar control and even lead to remission in some cases of type 2 diabetes.

Here are some steps you can take to navigate this situation:
1. Seek a Third Opinion: If you are receiving conflicting advice, it may be beneficial to consult another healthcare provider, preferably an endocrinologist who specializes in diabetes management. They can provide a more comprehensive evaluation of your condition and help clarify the best course of action.

2. Ask Questions: When you meet with your healthcare provider, don’t hesitate to ask questions about their recommendations. For example, you might ask why they believe medication is necessary despite your normal blood sugar levels or how they view the role of lifestyle changes in managing your condition.

3. Consider a Diabetes Educator: A certified diabetes educator can provide valuable insights into managing diabetes through diet and exercise. They can help you create a personalized plan that aligns with your health goals and preferences.

4. Monitor Your Health: Keep track of your blood sugar levels, HbA1c readings, and any symptoms you experience. This information can be helpful for your healthcare providers in determining the best management strategy for you.

5. Lifestyle Modifications: Regardless of whether you choose to take medication, focusing on a balanced diet and regular physical activity is crucial. Aim for a diet rich in whole foods, including vegetables, lean proteins, whole grains, and healthy fats. Regular exercise can also help improve insulin sensitivity and lower blood sugar levels.

6. Stay Informed: Educate yourself about diabetes management. Understanding your condition can empower you to make informed decisions about your health. Reliable sources include the American Diabetes Association and other reputable health organizations.

7. Trust Your Instincts: Ultimately, you know your body best. If you feel uncomfortable with a particular treatment plan or if something doesn’t seem right, trust your instincts and seek further clarification or a second opinion.

In conclusion, managing diabetes can be complex, especially when faced with conflicting advice. It’s essential to advocate for your health, seek multiple perspectives, and prioritize lifestyle changes that can positively impact your condition. Remember, you are not alone in this journey, and there are resources available to support you in making informed decisions about your health.

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