March 27, 2009
A1c (Glycohemoglobin, HgbA1c), Type 2
Question from Venedocia, Ohio, USA:
In early December, I was diagnosed with type 2 diabetes. At that time, my A1c was 6.6 and my fasting blood sugar was 135 mg/dl [7.5 mmol/L]. The nurse called from the doctor’s office and asked where to call in a prescription for metformin. I requested a meter, which surprised her. I put myself on a diet of about 45 grams of carbohydrates per meal, with a bedtime snack of about 15 grams of carbohydrates. When my blood sugars stayed elevated, I called about increasing the metformin, and it was increased to 500 mg twice a day (from once a day). I have not seen my doctor since diagnosis. If I didn’t have a daughter with type 1, I’d have no idea what to do.
I have now lost 14 pounds. I know I need to lose more weight, but I’m pleased with what I’ve lost since I’ve had the holidays and a great deal of stress (six hospitalizations between my parents and daughter since I was diagnosed). Today, I got the results of my second A1c. The nurse who called me told me it was excellent and the doctor was very pleased with my results and I should just keep on doing what I’m doing. It was again 6.6. I questioned the statement that this was great and suggested that it should be better given the work I’ve done. I was assured it was great and that no changes were needed.
It’s discouraging that the work I’ve done hasn’t had any impact on my A1c. I told the nurse I thought the current recommendations were for lower A1cs, but she assured me that anything under 7 was perfect and the doctor didn’t want to increase my medication. I’m also concerned because my blood sugars are creeping higher and most of my morning blood sugars are now over 120 mg/dl [6.7 mmol/L]. Should I be seeking a different doctor?
Answer:
Your question is colored by your disappointment with your A1c and the fact that the amount of work you have put into your lifestyle changes has not resulted in the desired change in control. This is a very common feeling. I can tell you that you are still much better off than before. You are on your way. Previously, you did not know if you could make these changes. The fact that your A1c did not change at all is somewhat disappointing. I would say that some physicians would attempt to push the metformin dose up and normalize the A1c, if possible. I think that diabetes care is both intensive for the patient and the physician. Some physicians approach it more intensively than others. There may be an element of truth in your thought that you may get another response from another physician. The American Diabetes Association would suggest that an A1c under 7% is desired, but attempts should be made to make the A1c as low as possible without increased risk. Since the A1c did not come down from the initial value, increasing the metformin dose may help and it is also associated with weight loss. As long as the dose is increased in a way that allows for monitoring for any gastrointestinal symptoms, this is usually okay. However, it should be noted that I am not suggesting you make any changes without talking with your physician. These issues you bring up might be best brought up when you visit with your physician face-to-face.
JTL
