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June 9, 2002

Complications

Question from Boston, Massachusetts, USA:

I have had a diabetes for 10 years, and most of my A1cs have been 5.2- 5.9%, but I was not checking my sugar on a daily basis very often. However, for the last three to four months, I've been checking my sugar at least six times a day, and I find that sometimes my reading an hour after breakfast is 220-230 mg/dl [12.2-12.8 mmol/L], although it then it drops to under 150 mg/dl [8.3 mmol/L]. Also, I get high readings after lunch (230 mg/dl [12.8 mmol/L]) for at least two-three hours. My morning is always good (80-90 mg/dl [4.4-5 mmol/L]). Lately, I've been very depressed because I'm thinking that even though my A1c (4.5% a week ago) is good, I will still get complications and my life is pretty much over. I lost hope and trust in A1c test. What is your opinion? How bad are those spikes? Am I damaging myself every time my sugar goes up even if it's high only for an hour or two?

Answer:

Please cheer up. Anyone doing as well as yourself should take pride in your accomplishments. Note that hemoglobin A1c is the test that has been directly tested against the risk of developing microvascular complications. There are no better indicators of risk. You are doing great.!

Another way to look at it would be that you are doing well, but may even do better by improving postprandial blood sugars. The first question I would ask is what insulin are you using with your meals? Are you using an analog such as Humalog or Novolog? These would be preferred over Regular insulin. It is important you speak with your physician about your results. No changes should be made in your regimen until you discuss these with your physician.

JTL