What is the management plan for a patient with controlled glucose levels who is not on insulin?

Management Plan for Patients with Controlled Glucose Levels Not on Insulin

For patients with controlled glucose levels who are not on insulin, the management plan should focus on lifestyle modifications including individualized nutrition therapy, regular physical activity, and ongoing monitoring to maintain glycemic control.

Lifestyle Management

Nutrition Therapy

• An individualized medical nutrition therapy program, preferably provided by a registered dietitian, is recommended for all people with diabetes 1
• Focus on nutrient-dense carbohydrate sources high in fiber, including vegetables, fruits, legumes, whole grains, and dairy products 1
• For those with type 2 diabetes, a consistent pattern of carbohydrate intake with respect to time and amount may help maintain glycemic control 1
• Avoid sugar-sweetened beverages (including fruit juices) to control glycemia and weight 1
• Limit daily fat intake to 30% or less of calories, with less than 7% from saturated fat 1

Physical Activity

• Exercise regularly for 30-60 minutes daily at an intensity of at least a brisk walk 1
• Regular physical activity improves glucose and HDL cholesterol levels, decreases stress, and helps normalize weight 1
• Physical inactivity is associated with a two times higher risk of cardiovascular disease in diabetes patients 1

Weight Management

• For overweight or obese individuals, weight loss of at least 5% is recommended to produce beneficial outcomes in glycemic control, lipids, and blood pressure 1
• Aim for a 500-750 kcal/day energy deficit or provide 1,200-1,500 kcal/day for women and 1,500-1,800 kcal/day for men, adjusted for baseline body weight 1
• Men should maintain a waist size of 40 inches (102 cm) or less, and women should maintain a waist size of 35 inches (88.9 cm) or less 1

Monitoring

Blood Glucose Monitoring

• Regular self-monitoring of blood glucose (SMBG) is essential for patients to understand how food, physical activity, and other factors affect their glucose levels 2
• Target fasting glucose of 70-130 mg/dL and postprandial glucose <180 mg/dL 2
• Test blood glucose frequently and at critical times to identify patterns 1

Regular Follow-up

• Check A1C every 3 months until target is achieved, then at least twice per year if stable 2
• Regular screening for complications including microalbuminuria, retinopathy, and neuropathy 1

Education and Self-Management

Diabetes Self-Management Education and Support (DSMES)

• Provide comprehensive diabetes self-management education to improve adherence and self-care behaviors 2
• Teach patients how food, physical activity, and other factors affect their blood glucose levels 1
• Educate on recognizing and managing hypoglycemia, even though risk is low when not on insulin 1

Common Pitfalls to Avoid

• Neglecting regular follow-up appointments and A1C monitoring even when glucose appears controlled 2
• Failing to adjust the management plan as the disease progresses 1
• Not providing adequate education about the importance of consistent lifestyle modifications 1
• Overlooking the cardiovascular and renal benefits of certain medications (like SGLT2 inhibitors) that may be appropriate even when glucose is controlled 2

When to Consider Medication

• If lifestyle modifications alone fail to maintain glycemic control, consider adding metformin as first-line pharmacologic therapy 1
• For patients with cardiovascular or renal disease, consider SGLT2 inhibitors or GLP-1 receptor agonists for their protective effects beyond glucose control 1, 2
• If A1C rises above target despite lifestyle modifications, a stepwise approach to medication should be implemented based on individual factors 1

By following this comprehensive management plan, patients with controlled glucose levels who are not on insulin can maintain good glycemic control while reducing their risk of diabetes-related complications.