June 25, 2012
A1c (Glycohemoglobin, HgbA1c), Hyperglycemia and DKA
Question from West Columbia, South Carolina, USA:
If a teen with diabetes has an A1c over 10, what will happen? I already have diabetic neuropathy. Will they put me in the hospital? My meter is filled with highs, including many in the 400s mg/dl [22.2 to 27.7 mmol/L], the highest being 487 mg/dl [27.1 mmol/L]. I have a doctor’s appointment next month. The last time I went, my meter was also filled with highs. The doctor told me to be careful, that my a1c was 9.5, but I just know it went up. If the doctor keeps warning you about it, will they put you in the hospital if it’s the second time? I can’t afford an insulin pump. I do not count carbohydrates. My family is on a fixed income. I take three shots a day, one when I wake up, one at dinner, and one before I go to sleep. I have been eating all of the right things. I do eat three meals a day. I drink more than eight glasses of water every day. I forgot what my insulin to carbohydrate ratio was. I always use my insulin every day when I am supposed to. Is a hospital stay still possible? I am doing everything I am told. My blood sugars are still way too high. When I wake up every day, my blood sugar will be in the 200s mg/dl [11.1 to 16.6 mmol/L] or 300s mg/dl [16.7 to 22.1 mmol/L] and I do not know why.
Answer:
You need to discuss with your physician what it is that will improve your blood sugar. Putting you in the hospital is not always the best thing, because it is an artificial environment. You need your basal insulin addressed so that you do not start the day in the 300s mg/dl [16.7 to 22.1 mmol/L]. The basal insulin would be your long-acting insulin, such as NPH, Lantus, or Levemir. Then, you need to focus on your bolus insulin. Not knowing your ratio is a key problem. Call. Get over the issue of having to communicate with your provider. The day-to-day highs are going to cost you in the long run if you do not get them down. The ratio helps adjust or cover the amount of food you eat with the correct amount of insulin. Just guessing at a dose is not good. If you come prepared to ask these questions, you will be looked at as being serious and getting at the heart of how to control your sugars. Although an economic status is a definite hardship, there are things you can control that are independent of the money situation.
JTL
