Experts say that there is a balancing act between medication, insulin and lifestyle that needs to be considered when designing a treatment plan.
The drug treatment of type 1 and type 2 diabetes is more complicated than you think.
And finding the right balance may be harder than expected.
A recent study came to the conclusion that some people with diabetes suffer from diabetes to be over-treated, and their treatment plan is actually too intense.
Some previous research has found that the majority of people with type 2 diabetes are not treated aggressively enough and do not see any improvement in their blood sugar levels.  However, the recent study reports that a number of people taking insulin or other diabetes medications are suffering from hypoglycaemia (low blood sugar levels) that is severe enough to get them into the ER.
States received more medication than required to meet their HbA1c targets. They directly contributed 4,774 hospital admissions and 4,804 emergency medical visits during the course at two years old.
The study estimates that approximately 20 percent of adults with diabetes will be over-treated in the US – especially those with type 2 diabetes. This means that about 2.3 million people were over-treated between 2011 and 2014, the study said.
"This is not a groundbreaking science," Dr. Rozalina McCoy, endocrinologist and family physician at the Mayo Clinic in Minnesota and a senior researcher of the study told Healthline: "But it shows the real human impact of over-intensive treatment in a patient with diabetes," she explained.
"We as clinicians know that we should not be over-treated as older patients or patients with multiple medical conditions, but other patients may also be over-treated. The tribute a patient's life demands is real, especially when he gets up in the emergency room.
While a person might be taking an oral or injectable diabetes medication or receiving insulin injections to treat diabetes the way these medications work are very different.
In addition, the amount of insulin that a person needs for different times of the day or different aspects of blood glucose management varies.
The amount of medication or insulin a person needs is based on a number of factors such as body weight, age, activity level, diet, stress, and overall beta cell function.
These factors largely determine whether or not a person with type 2 diabetes may need insulin.
"Although type 1 diabetes is incredibly challenging and very complicated. We at least understand why there is low blood sugar, "McCoy said." As a clinician, we generally know where to begin when we adjust their treatment. These serious and recurrent hypoglycemic events should not be mitigated.
She added, "In type 2 diabetes, it's much harder to pinpoint the exact problem – especially if a patient's A1c is still high, but many suffer from hypoglycaemia. "
McCoy said many clinicians do not know how easily a person with type 2 diabetes can develop hypoglycaemia. Overall, the rate of low blood sugar in type 2 diabetes is lower than in type 1 diabetes, but the incidence in type 2 patients is higher than previously thought.
"One problem that contributes to this problem is the following: The risk of hypoglycaemia for a patient with type 2 diabetes does not occur immediately upon initial diagnosis," McCoy said.
"First, they try to control their diabetes through diet, exercise, and metformin – which can not cause low blood sugar.
Hypoglycaemia is expected in a person with type 1 diabetes and is essentially part of the diagnostic package.
A person with type 1 diabetes is immediately cleared up about the signs and symptoms of low blood sugar, what can they cause, how can they be treated and how can they prevent them from occurring too frequently.
A person with type 2 diabetes will only receive a financial refund from their health insurance if they seek a diabetes counselor Specific number of years after the initial diagnosis.
If you are taking more intensive diabetes medication or insulin, the possibility of thorough education about blood glucose management may be minimal for cost reasons.
"Only a small fraction of Type 2 patients receive adequate education because there are not enough diabetes counselors, not enough time with doctors and not enough financial reimbursement if they start taking insulin years later," said McCoy.
"The Risk of Low Risk Blood sugar in a low-A1c patient is actually very low because it is not normally treated intensively. "
The higher the person's A1c, McCoy said, the higher the risk of hypoglycaemia. The doctor may intensify the treatment by increasing the dosage or adding extra medication to lower blood sugar levels.
People with type 1 diabetes learn how to count carbohydrates and how to adjust their insulin dose to the amount of food they want to eat.
One unit too much or too little can easily lead to high or low blood sugar, but people with type 1 are taught it to expect these fluctuations, and encouraged them to check their blood sugar several times a day to get this kind of To overcome the 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 important it is that the amount of food they eat matches the insulin dose, or how they adjust it if they do not want to eat so much.  Too often people with Type 2 are advised to take "X" insulin at each meal. This means they need to consume "X" carbohydrates to reach this insulin dose.
This causes a problem with "feeding your insulin," which can lead to overeating, weight gain, and dangerous blood sugar fluctuations if you do not eat enough to get the insulin dose.
"Type 2 diabetes is thought to be easier to manage than type 1 diabetes, but the moment a patient is prescribed with type 2 insulin, we should treat them more like a patient treat with type 1 diabetes, "McCoy said.
"One of the Biggest Things I Do with My Type 2 Patients Taking insulin is reversing the prescribed insulin dose and the prescribed carbohydrate quantity at each meal," McCoy explained.
"If you're not ready to learn how to count carbohydrates and specifically adjust the insulin dose, we'll talk about dosing for meals in more general terms of" small "or" small. "Medium or large meal with insulin dose options for each size. It is still better to keep an eye on the meal than to force a patient to eat a certain amount to cover the insulin dose he should take regardless of the situation, "she explained.
Gary Scheiner, CDE, author and director of Integrated Diabetes Services of Wynnewood, Pennsylvania, said he accepts McCoy's views to some extent.
"Glucose targets need to be individualized based on the capabilities, risks and limitations of a patient," Scheiner told Healthline.
"Stronger not." For example, in patients at risk of falling, such as older people, or in patients with hypoglycemic unconsciousness, in which they can not physically feel the symptoms of low blood sugar levels, in patients in high-risk areas and in children. " On the other hand, Scheiner argues that for some people a more intensive treatment is worthwhile and the risks of low blood sugar are part of the pursuit of a healthier blood sugar level.
"In patients with diabetes complications, as with retinopathy, in patients entering pregnancy, or in patients seeking to maximize exercise, more stringent control is generally desirable. "
Scheiner added that one of the biggest mistakes that clinicians have to worry about is submitting a stricter glycemic control and a lower one. A1c automatically reduces the long-term risk of a complication.
"That just is not true," said Scheiner. "There are several factors that cause complications – not just about blood sugar levels – and there is a point where more accurate control is of no use. Like taking 10 aspirin for a headache instead of two.
"And of course there is a point where the risks outweigh the benefits. For a person taking insulin, wearing a continuous blood glucose meter has helped shift the curve by alerting patients when they approach low blood sugar levels to help prevent more severe hypoglycaemia. "
Again, it depends on the individualization of the treatment plan of a patient, which can not be performed properly in a five-minute appointment.
"Treating diabetes with a consistent approach will not work," McCoy said.
"I have." The luxury of 30-minute appointments in the Mayo Clinic and sometimes that's still not enough. What is the life of the patient? What are their resources and support systems? How can we help them safely integrate diabetes into their routine? "
To really reduce the number of hospital visits associated with hypoglycaemia, the bigger problem that needs to be addressed is far more than changing the prescription of insulin by doctors. Instead, they may need more time for their patients.
"An appropriate treatment plan," McCoy explained, "depends on a good relationship with the patient."
Ginger Vieira is an experienced patient with type 1 diabetes, celiac disease and fibromyalgia. Find her diabetes books at Amazon and connect to her on Twitter and YouTube .