Diabetic Labs: what are those every 3 month tests for?

Every 3 months, you should have a test done called a glycohemoglobin A1c, or glyco for short.

This is a test that tells us what your average (mean, actually, if you are savvy about statistics) blood sugar has been over the prior 2-3 months.

What it actually is is a measurement of glucose (blood sugar) molecules that have become stuck to hemoglobin molecules in your bloodstream. Hemoglobin is the large molecule in your red blood cells that helps to pick up and deliver oxygen to your organs.

Naturally, the normal number is not zero since you'd have to have no blood sugar or no hemoglobin!

People without diabetes have a glyco between 4.0 and 6.0, where 5.0 is an average blood sugar of 100.

If you have diabetes, this test result would be higher because your blood sugar is higher than it should be.

The glycohemoglobin test is useful because it tells us how well controlled your blood sugars have been over a 2-3 month period around the clock and not just at times you check it or the morning you go to the lab. Here is a table that shows how high your average sugar is depending on your glyco test result. A rule of thumb is add 40 points for every 1.0 above a test result of 5.0.

The American Diabetes Association recommends a glyco of under 7.0, however endocrinologists (specialists in gland disorders, including diabetes) recommend under 6.5.

I recommend this lower goal of under 6.5, too.

Under 7.0 does reduce your chances of diabetes causing damage to small blood vessels and causing blindness, nerve pain, kidney failure, erectile dysfunction (male impotence) and circulation problems to your feet.

However, getting the glyco under 6.5 accomplishes this and also prevents damage to larger blood vessels and thereby reduces your chances of having a cardiac arrest, heart attack or stroke. I think it's worthwhile going for the brass ring here, as long as efforts to do so are not causing problems with hypoglycemia or medication side-effects.

As to that computer print-out you get at the lab, do not worry about it!

• It is not a bill, and signing it does not mean MediCare or your insurance will bill you. (If you don't believe this, read the fine print carefully and think like a contract lawyer while you're doing it.)
  
• MediCare covers glyco tests every 90 days for stable well-controlled diabetes. When they say 90 days, they mean it so do know when was the last one so you can avoid this problem. Feel free to ask, too.
• If your diabetes is not well-controlled as your doctor defines it, then MediCare will pay for glyco tests more frequently than every 90 days.
• We are very careful to make sure that your lab forms reflect this, so that if we instruct you to get tests done more frequently, this will not result in a billing problem for you.
• Bear in mind that the lab simply generates a form any time they are asked to do any test for any reason where MediCare may have a time limit! THIS IS NOT THE SAME THING AS BEING TOLD YOU WILL BE BILLED. THIS IS COMPUTER-GENERATED PAPERWORK!

End of rant ; . )

Diabetic Blood Sugar Goals: where should my blood sugars be?

If you have diabetes, checking your blood sugar is a great way of being able to instantly tell how your body is responding to your diet, exercise habits and medications (whether pills, insulins, or both).

The latest generation of glucometers (finger-stick blood sugar monitors) are easier to use than older ones as they need such a small amount of blood you can test easy and less painful sites such as the forearm or sides of the fingers.

As for how low your sugars should be, the answer is basically as close to normal as possible without going so low that hypoglycemia (low blood sugar) occurs.

Fasting (first thing in the morning and pre-meal sugars should be low enough to reflect good overall blood sugars. After eating, sugars will of course be higher since your body is breaking down your food and absorbing vital nutrients into your blood for use and storage. This includes glucose, or blood sugar.

Good goals to meet are:

Fasting or pre-meal: 70-130
1 hour after eating: under 280
2 hours after eating: under 180
3 hours after eating: under 150

Notice that these goals may vary somewhat depending on the recommendations of various medical organizations (such as here, and here).

Where these recommendations all agree is that the goal is to keep your sugars as close to normal as is possible and safe, so that your are reducing as much as possible the risks of diabetes harming your body.

More coming up on what to do if your sugars are too high, and what are those every 3 month lab tests for?

Diabetes control: low blood sugars

Having addressed blood sugar goals, and treatment of high sugars, what about lows?

Developing low blood sugar (hypoglycemia) can be frightening, since most people find that they suddenly feel very shakey, weak "like someone just pulled the plug on me". If your blood sugar reading is under 70 (which means a lab would find that it is under 55- 60) or has dropped quickly over a short period of time to low-normal levels, then you may find your self feeling this way all of a sudden. If you do, DO. NOT. PANIC.

If it is convenient and safe to do so, go ahead and check your blood sugar. Certainly, if your were in a hospital or ER and said this was how you felt, we'd stick your finger immediately and find out if that was the trouble.

If it is indeed low, then have something to eat or drink. Orange juice is fine, but really anything with a few carbs is okay. A piece of bread, a few crackers a piece of candy, a piece of fruit will do just fine. You should feel back to normal in a few minutes. If you don't, then re-check your blood sugar.

It is generally not necessary to eat large amounts of food or drink over the few minutes until the hypoglycemic symptoms resolve. This can result in weight gain and very high blood sugars for hours afterwards.

The goal is to get low sugars back up into a normal range of less than 125 quickly and safely without feeling compelled to over-do it.

Certainly, frequent episodes of low sugars are something we should discuss to determine whether any of your medications doses are too high.

Low sugars that don't respond to eating, keep dropping back or are causing fainting or near-fainting are a serious emergency for which you should call 911 or be taken to an emergency department.

Is Avandia safe?

Bottom Line: so far, appears to be safe.

So, what's the issue?

A recent study was done that lumped together a number of separate studies (this is called meta-analysis), and it suggested that people on Avandia may have more heart attacks or heart failure than people who don't take Avandia. (Bear in mind, that the manufacturer and the FDA are involved in looking at the safety of the drug, but are not felt to have been at fault in some way.)

Problem is, meta-analysis is kind of a forced apples-orange comparision and is known to produce conclusions that have to be carefully considered.

So far, investigations looking specifically at whether Avandia carries an increased risk of heart disease do not show an increased risk. Naturally, these findings will be made public as they are concluded.

In the mean time, it's worth bearing in mind that poorly controlled diabetes itself carries a very high risk of heart attack. Because the question of drug-related heart risks is inconclusive, it is probably better to use Avandia to keep your diabetes under good control.

[This posting is for general information, and is not a substitute for individual assessment or advice!]

Can I keep from becoming diabetic?

Short answer; yes.

This doesn't seem to get as much media airplay as it should, but then no one stands to profit much by extolling the virtues of moderate diet and exercise habits.

Becoming diabetic should concern you if you are overweight, and especially if diabetes runs in your family, you have high blood pressure or abnormal cholesterol tests. In fact, it's not so much what the scale says as your waist circumference (at the belly button, not at the hips). Over 40 inches in men and over 35 inches in women predicts folks who are likely to develop diabetes.

The good news?

Losing weight can reduce your odds of becoming diabetic by about 80% or more, and it doesn't take as much as you probably think. Losing 5-7% of your weight will do it. If you weigh 200 pounds, that means losing 10-14 pounds, not the usual 30-50 pounds that people often say if I ask them.

This can be done by limiting your calories to 1,800/day, avoiding any food over 30% calories as fat (check the Nutritional Fact labels) and getting a fast walk in for 30 minutes, 5 days a week. Just enough to break a little sweat will do. Sorry, "being on my feet all day" doesn't help. Yes, just eating smaller portions does help. The problem here is that many people eat up to 3,000 calories a day!

Most folks can lose about 4-6 pounds a month this way. 10 pounds off lowers your blood pressure by 8-10%, which is as good as starting doses of medicines for this. 7% weight loss, and you really cut down your odds of ever seeing me every 3 months for diabetes.

You get a taste for it and want to keep losing weight because you feel better and like what you see in the mirror, well the rest is gravy!