Diabetes Management in Troy, MI

Understanding diabetes

Diabetes develops when the body makes too little insulin or does not use it effectively, allowing glucose (blood sugar) to build up. Over time, it can harm the eyes, kidneys, nerves, heart, and feet. Treatment and regular follow-up reduce these risks.

Possible symptoms include thirst, frequent urination, fatigue, blurred vision, unexplained weight loss, slow-healing sores, or tingling feet. Type 2 diabetes may have no symptoms for years.

The American Diabetes Association recommends screening from age 35, or earlier for adults with overweight or obesity and additional risk factors. Testing is usually repeated at least every 3 years if normal, and sooner when risk is higher. Symptoms warrant assessment at any age.

How diabetes is diagnosed

These laboratory thresholds apply outside pregnancy. Pregnancy uses different testing criteria. Home meters and CGM sensors do not establish a diabetes diagnosis.

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A random laboratory plasma glucose of 200 mg/dL or higher can diagnose diabetes when accompanied by classic symptoms, such as thirst, frequent urination, and unexplained weight loss, or a hyperglycemic crisis. Without clear symptoms or a crisis, two abnormal results are needed: repeat testing or two different abnormal tests.

Anemia, blood loss or transfusion, some hemoglobin variants, pregnancy, and other conditions can affect A1C accuracy. Your clinician will choose the appropriate test.

How diabetes medicines work

Healthy eating, activity, sleep, and avoiding tobacco support every care plan. The options below mainly treat type 2 diabetes and do not replace insulin in type 1. Choice depends on glucose levels, heart and kidney health, weight, side effects, cost, and your preferences.

This is an overview, not a complete list of medicines or side effects. Follow your prescribed plan, including sick-day instructions. Ask in advance which medicines to pause before surgery or when you cannot eat or drink normally. Do not stop essential insulin on your own.

When is insulin needed?

Insulin replaces or supplements what the pancreas makes. It is essential in clinical type 1 diabetes and may also be needed in type 2 diabetes. Needing insulin is not a personal failure.

• Very high glucose or symptoms: insulin may be considered with A1C above 10%, glucose of 300 mg/dL or higher, marked thirst or urination, or unexplained weight loss. These are clinical decision points, not instructions to start insulin yourself.
• When other treatment is insufficient: insulin can be added if individualized goals are not reached. For many people with type 2 diabetes without severe hyperglycemia, a GLP-1-based treatment is considered before insulin.
• Special situations: illness, surgery, steroid treatment, or pancreatic disease may increase insulin needs. During pregnancy, insulin is the preferred medicine when medication is needed; care is coordinated with the pregnancy team.

We review insulin technique, glucose patterns, and low-glucose episodes during follow-up. Ask about rescue glucagon and a sick-day plan. Some people with type 2 diabetes can later reduce or stop insulin under supervision; people with type 1 need ongoing insulin. Endocrinology referral may be appropriate for complex care.

Continuous glucose monitoring: FreeStyle Libre 3 and Dexcom G7

Our practice uses continuous glucose monitoring (CGM), including FreeStyle Libre 3 and Dexcom G7, when appropriate. A small wearable sensor estimates glucose in the fluid beneath the skin and sends readings to a compatible phone or reader/receiver.

CGM provides a view of glucose patterns throughout the day and night. It can help reveal after-meal rises, overnight changes, and episodes of low glucose that occasional finger-stick checks may miss.

We can review your glucose reports during follow-up to guide treatment decisions. Device choice depends on clinical needs, compatibility, availability, and insurance coverage. Sharing CGM data does not mean that the office monitors it continuously or provides emergency alerts.

Using CGM safely

Keep a blood glucose meter available. If sensor readings do not match how you feel, or the device instructs you to check, use a finger-stick measurement and follow your care plan and the manufacturer’s instructions. CGM measures glucose; it does not deliver insulin by itself.

Follow your agreed insulin plan rather than making unplanned dose changes in response to individual readings. Review alert settings and what to do for low or high glucose with your care team.

Care beyond the glucose number

• Personalized goals: Review A1c and glucose patterns, with attention to avoiding low blood sugar.
• Medication review: Consider effectiveness, side effects, kidney health, cardiovascular risk, and cost.
• Complication prevention: Keep up with kidney blood and urine testing, eye examinations, and foot care as recommended.
• Heart health: Address blood pressure, cholesterol, and tobacco use.
• Daily habits: Build practical nutrition and activity goals, with diabetes education or nutrition referral when helpful.

An A1C below 7% is a common goal for many nonpregnant adults, but targets may be higher or lower depending on health, age, pregnancy, and risk of low glucose.

Prepare for your diabetes visit

Bring your medication and insulin doses, CGM reader or phone, glucose records, and recent lab results. Note any low-glucose episodes and questions about meals, activity, or device use. Ask our team how to make your CGM reports available for review.