With type-2 diabetes, it’s important to keep blood sugar under control, but there’s also a danger in using too many drugs to bring levels to unhealthy lows, says Dr. Rozalina McCoy, from the Mayo Clinic.
McCoy and her colleagues report in JAMA Internal Medicine about a study of more than 31,000 adults with type 2 diabetes. They analyzed those who were treated aggressively to see how often they experienced dangerously low levels of blood sugar requiring hospitalization or other medical care. They considered aggressive treatment any case in which people were taking multiple medications to keep their blood sugar levels down.
About 20% of the people in the study fit this category, and such aggressive treatment, says McCoy, might have actually done them more harm than good. For people who are older and have other health problems, aggressive treatment of their diabetes led to a complications including dizziness, fainting and in sever cases, seizures and coma.
“Our goal in managing diabetes is to really get people’s blood sugar into a safe, normal range. Which means not too high—but it also means not be too low,” says McCoy. “And this applies to many people, not just the people in the study.”
While the risk was highest for people who are older and those with other health problems, McCoy says there is a lesson for everyone with diabetes, and for the doctors who treat them. “In an effort to reduce undertreatment, and to make sure patients are tested and receive the appropriate treatment medications, we don’t have a counterbalance to ensure that patients are not over treated.”
She points to several factors in the aggressive over treatment, the most important of which are guidelines and recommendations that focus on reducing blood sugar without a companion emphasis on warning against what levels can be too low. The long-term health dangers to high blood sugar include damage to the kidneys, eyes and risk of amputation. The harms of low blood sugar are more immediate, and should also be part of any doctor’s treatment of people with diabetes, McCoy says.
She hopes the results of the study serve as a lesson for all doctors, not just those who treat people with diabetes. “The same principle applies to many chronic diseases,” she says. “We may hurt patients in our desire to help them if we do too much.”
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