It has come to my attention that certain health care providers in this community have been making
comments that because my non-insulin-requiring diabetic patients are not testing their blood sugar
levels up to four times a day, that my diabetic patients are being treated by out-of-date methodology (I
follow blood sugar levels, fasting and two-hour after breakfast), and that they are not being adequately
treated since I do not run urine micro-albumin levels.
I have been taking care of non-insulin-requiring diabetics for almost 40 years, and my diabetics who have
never smoked cigarettes and who follow my treatment directives die at an average age of 80 years, which
is beyond the normal lifespan. Not one of them has developed proliferative retinopathy or renal failure
bad enough to warrant dialysis.
The argument against testing blood sugar levels up to four times a day in non-insulin-requiring diabetics
is borne out by four RCT’s, and all of them showed that tight control of blood sugar is not beneficial
and may indeed be harmful. The argument against using HbA1C as a screening/therapeutic measure is that
it is not always accurate and may result in the misdiagnosis of diabetes, when in fact the patient does
not have diabetes. The HbA1C represents the average blood sugar over the last six months, but mainly the
last three months, not the immediate three months past. The HbA1C was promoted as a convenient way to
assess diabetic status and is comprised of both the fasting and the two-hour after breakfast blood
sugars. So if I follow these two tests, I get the same information as the HbA1C, but I get the
information in real time, not 3-6 months ago. Finally, measuring the urine microalbumin levels will not
change my treatment, so why should I order a test that will not change what I do? Diabetics should be
treated to prevent atherothrombotic disease and that means good control of cholesterol and blood
pressure and above all the cessation of cigarette smoking. Blood sugar should be treated to keep the 2
hour after breakfast blood sugar below 200 mg/dl.
These arguments are part of the rationale for why I do what I do, and my patients do quite well.
W.E. Feeman Jr., MD
Bowling Green