Experts claim that there is a balancing act of drugs, insulin and lifestyle changes that must be taken into account when drawing up a treatment plan.
Treating type 1 and type 2 diabetes with medication is more complicated than you might think.
And finding the right balance can be harder than expected. A recent study concluded that some people with diabetes were
Some past studies show that the majority of people with type 2 diabetes are not treated aggressively enough and do not see improvements in their blood sugar levels.  However, a recent study reports that a number of people taking insulin or other diabetes medications experience hypoglycaemia (low blood sugar) severe enough to send them to the emergency room.
The study found that when US patients received more medication than needed to meet their HbA1c goals, it directly contributed to 4,774 hospitalizations and 4,804 emergency visits over two years.
The study estimates that about 20 percent of adults with diabetes in the United States are treated – especially those with type 2 diabetes. That means that about 2.3 million people were treated between 2011 and 2014, the study explained.
"This is not a breakthrough science," Dr. Rosalina McCoy, an endocrinologist and primary care physician at the Mayo Clinic in Minnesota, and
"But it does show the real impact of human over-treatment in a diabetic patient," she explained.
"We as clinicians know that elderly patients or those with multiple medical conditions should not be satiated, but other patients may also be treated. The cost of the fee for the patient's life is real, especially if he is wound up in the emergency room. "
While a person may take an oral or injectable drug for diabetes or have injections with insulin to treat diabetes, the way these drugs
in addition, the amount of insulin that a person needs for different times of The day or different aspects of blood sugar management vary.
The amount of medication or insulin a person needs is based on a number of variables, including body weight, age, activity level, diet, stress and overall beta-cell function.
These factors largely determine whether a person with type 2 diabetes will eventually need insulin or not.
"Although type 1 diabetes is incredibly challenging to live with and is very complex, we at least understand why low blood sugars happen," McCoy says, "and as clinicians, we usually know where to start when making adjustments." in his treatment nt to reduce those severe and recurrent hypoglycemic events. "
She added:" With type 2 diabetes it is much more difficult to determine the exact problem – especially when the patient's A1c is still high, but he has frequent hypoglycemia, and they
McCoy say that many clinicians do not realize how easily a person with type 2 diabetes can experience hypoglycaemia.In general, the percentage of low blood sugars in those with type 2 diabetes is lower than that of type 1, but it is higher in people with type 2, "
" One problem that contributes to the problem is that the risk of hypoglycaemia for a patient with diabetes Type 2 is not coming as soon as they are put first, "said McCoy.
"First, they try to manage their diabetes through diet, exercise and metformin – which cannot cause low blood sugar."
In a person with type 1 diabetes, McCoy said hypoglycaemia is expected and is essentially part of the diagnostic package.
A person with type 1 diabetes is immediately educated about the signs and symptoms of low blood sugar, what can cause them, how to treat them and how to prevent them from occurring too often.
A person with type 2 diabetes will only receive a financial refund from his or her health insurance plan to see the diabetes teacher for a specific number of years after the initial diagnosis.
At the time when more intensive medicines for diabetes or insulin are started, the opportunity for comprehensive blood glucose management training may be minimal because of the cost.
"Only a minority of type 2 patients receive adequate education because there are not enough diabetes educators, not enough practitioners, and not enough financial years to recover when they start taking insulin," McCoy says.
" The risk of low blood sugar in a patient with low A1c is actually very low because they are usually not in the intensive care plan, "she added.
The higher a person's A1c, McCoy explained, the more the risk of hypoglycaemia is higher, this doctor may increase l
People with type 1 diabetes have been taught how to count carbohydrates and adjust their insulin dosage to measure their amount of food, or to increase their dosage or to increase their blood glucose levels.
A unit of too much or too little can easily lead to high or low blood sugar, but people with type 1 are taught to expect these fluctuations and are encouraged to check their blood sugars many times a day for to help overcome this and kind of challenge.
People with type 2 diabetes are not encouraged to routinely check their blood sugar. They may take their insulin as prescribed, but they may not understand how necessary it is for the amount of food they eat to match the insulin dose, or how to adjust it if they do not want to eat so much food.  Too often, people with type 2 are told to take an "X" amount of insulin at each meal, which means they will need to eat an amount of "X" carbohydrates to respond to that dose of insulin.
This creates an "eating your insulin" problem that can lead to overeating, weight gain and dangerous fluctuations in blood sugar when you do not eat enough to meet the insulin dose.
'It has been suggested that type 2 diabetes is easier to manage than type 1 diabetes, but as soon as a type 2 patient is prescribed insulin, we should start treating them more like a type 2 diabetes patient 1, "McCoy says.
" One of the biggest things I do with my type 2 patients is taking insulin means 'canceling' a prescribed dose of insulin and carbohydrates at each meal, "McCoy explained.
"Instead, if they are reluctant to learn how to count carbohydrates and adjust their dose specifically and insulin, to mention the dosage of feeding in more general terms of "low" or "medium" or "large" feeding options insulin for each size. Eating nutrition is still better than forcing a patient to eat a certain amount of food to cover the dose of insulin they are told to take, no matter what, ”she explained.
Gary Scheiner, CDE, author and head of Integrated Diabetes Services in Wynnewood, PA, said he agreed with McCoy's estimates … to a point.
"Glucose targets should be individualized based on the patient's abilities, risks and limitations," Scheiner told Healthline.
always better – such as in patients at risk of falling, such as the elderly or those with hypoglycemic unconsciousness, during whom they cannot physically feel the symptoms of low blood sugar, those in high-risk professions and in children. " On the other hand, Scheiner claims that for some people it is worth the more intensive treatment and the risks of low blood sugars are part of the pursuit of healthier blood sugar levels.
"For patients who struggle with the complications of diabetes. such as retinopathy, patients undergoing pregnancy, or patients who wish to increase their athletic performance, for example, tighter control is generally desirable. "
Scheiner added that one of the biggest mistakes clinicians experience is accepting that tighter blood sugar control and lower A1c automatically reduce the long-term risk of developing a complication.
"That's just not true," Shiner said. "There are a number of factors that contribute to complications – not just glucose levels – and there are times when tighter controls just don't work. Taking 10 aspirin for a headache instead of two.
"And of course, there is a time when the risks outweigh the benefits. For a person taking insulin, wearing a continuous glucose monitor has helped to "shift the curve" by warning patients when approaching low blood sugar so as to prevent more severe hypoglycaemia, "he notes.
It again comes down to the individualization of a patient's treatment plan that cannot be properly performed within a five-minute appointment.
"Managing diabetes with a one-size-fits-all approach will not work," McCoy says.
“I have the luxury of 30-minute appointments at the Mayo Clinic and sometimes that is still not enough. What is the life of the patient? What are their resources and support system? How can we help them safely adjust diabetes to their routine? "
To really reduce the number of hospital visits related to hypoglycemia, the bigger problem that needs to be addressed can be much more than a change in the way doctors prescribe insulin. Instead, they may need more time with their patients.
"The right treatment plan," McCoy explained, "depends on a good relationship with the patient."
Ginger Vieira is an expert patient living with type 1 diabetes, celiac disease and fibromyalgia. Find her diabetes books on Amazon and connect with her on Twitter and YouTube .