“How should diabetes be treated in patients who have had it for a long time?”

If your mom is not controlled on the medication with A1C of 11%, she needs insulin therapy. She has had diabetes for too long and I recommend addressing this with an endocrinologist ASAP before she develops other problems like stroke or heart attack.

By going on insulin and other injectable diabetic drugs called GLP1 receptor agonists.

Hello,

An A1C of 11 is very elevated. As you mention, this is poorly control diabetes. If your mother is not on insulin at the moment she might need to be now. If already in insulin then insulin needs to be adjusted. With out knowing her kidney function I would suggest a SGLT 2 inhibitor which helps by urinating the excess sugar and a GLP1 agonist. Will help the pancreas produce more insulin and control carb intake. Your mom should seek the help of an endocrinologist to control her glucose. Also, as I like to tell patients remember that glucose control 80% is diet and 20% is medication (unless insulin dependent).

Medication alone will not restore blood glucose control absent lifestyle change. Your mother should speak with a nutritionist about balanced meals. She should also observe my '4 AM - 4 PM' rule that recommends major meals be consumed early in the day when metabolism is most efficient. The evening meal should be very light (e.g., salad). Proper meal planning should permit your mother to have a blood glucose below 140 mg/dL before breakfast and that usually sets the standard for the rest of the day.
For meal planning and diet information, check my website and my book on:
www.mer-llc.com

At this point a well tailored Insulin is the first thought. Yet a full history of complications and Diet and physical activity are necessary

It’s very important to start checking blood glucoses, reduce portions of carbs, and be consistent with diet. Often, medications may need to be adjusted to meet her daily routine so she takes them appropriately. Exercise!!! Eat healthy!!!

Endocrine consult

I would first determine whether your mother is still making insulin. If so, there may be new medications or combinations that would help. Otherwise she would be limited to insulin or drugs that can lower blood sugar but don't depend on insulin. I would make sure she is doing everything possible in the way of lifestyle changes such as diet, exercise, weight and stress control. Also, I would make sure she has no occult infection that may be causing high sugar levels due to insulin resistance. Finally I would make sure she is not on drugs like cortisone or prednisone, and numerous others, which can increase insulin requirements dramatically.

An HbA1c is much too high for anyone & must be lowered. You didn't tell me how old your mother was & what meds she is taking so I cannot completely answer you? But only speak generally. And here it is INSULIN. At this level of control, & duration of diabetes, probably only insulin will control her. She needs to see a diabetes specialist for 1) diet & exercise counciling 2) start insulin if she is not taking it now & if taking it adjust the dose & distribution of the doses. If I were seeing her & she were on oral agents I would stop all of them except metformin and starty a basal-bolus insulin regimen with a long acting insulin at night & short acting insulin before each meal. Test blood sugar 4x/d and adjust insulin as needed to get blood sugar under control & HbA1c down to at least 7.5 or 7 depending on age. Yes, it is causing complications & she must know that and get help. Early complications are reversible, but if they go on, can become irreversible and very disabling and even fatal. Get her help right away.