December 14, 2004
A1c (Glycohemoglobin, HgbA1c), Type 2
Question from Ames, Iowa, USA:
My recent yearly physical had one blood test, an A1c, and the result was 6.7. My doctor said I was creeping up to the 6.9 number which he said would mean I would need to take medication. This is the first I had heard this warning. I am 56, just had knee partial replacement surgery, and my weight went up to 240 pounds. I am 6 feet tall, a non-smoker, take two medications for blood pressure, which is well controlled with Norvasc/Accupril. I do not drink, but since my physical I have dropped to 222 pounds. I am really watching what I eat and have been, for some time now, but it is the holidays and treats add pounds, and I had knee surgery. Now, I am walking twice a day, and feel pretty slim at 222 pounds. I recently purchased an Accu-Chek blood glucose meter, strips, etc. and started checking my blood sugar three days ago. I downloaded a chart which has the conversion from plasma blood glucose to the equivalent A1c number. I have been charting my tests, by time and before and after eating and after walking. So far, my numbers look good to me. Are they better sounding to you? My 6:30 a.m. test, before my bowl of Fiber One, was 121 mg/dl [6.7 mmol/L], which is a 5.6 A1c equivalent. I had my cereal, went for a walk tested and got a 95 mg/dl [5.3 mmol/L]/4.8 A1c. I then drove down 30 minutes to get some better walking boots for winter, had lunch of chicken breast, baked beans, and cole slaw, drove home, waited two hours to test my blood sugar, which was 122 mg/dl [6.8 mmol/L], a 5.6 A1c. I had supper, went for a walk after an hour came home tested got a 95 mg/dl [5.3 mmol/L]/4.8 A1c. I have purchased a low carbohydrate diet book for reference for staying away from spiking foods, staying aware of food like white potato that can cause blood sugar to elevate. I feel pretty good. I work in an office setting. I rise early, start the day with a bowl of Fiber One, coffee and morning medications, then I head to work after a good shower. At 9 a.m., I walk for 15 minutes to the local grocery, get a banana, an apple and an orange, which I typically have for morning snacks. For lunch, I walk over and split a turkey sandwich with my wife and have a cup of soup. For afternoon snack, I usually have a low fat yogurt with a cup of soy milk. I have cut back on skim milk as well. For supper, it is usually tuna, no mayonnaise, a slice of stone ground wheat, and salad with vinaigrette oil. My question surrounds, this concept: my one blood test was at the high end of desirable, but I have not gotten near that number. Instead, my numbers look very respectable by comparison. Am I on the right track to control my numbers and stave off type 2 diabetes?
It sounds like your A1c went up because you weren’t exercising because of the knee problem. Now that you are back on track (no pun intended), you might be able to achieve the “targets” which are: less than 120 mg/dl [6/7 mmol/L] before meals and less than 140 mg/dl [7.8 mmol/L] two hours after you start to eat a meal. You should see a diabetes educator to learn how to count carbohydrates. Some of your meals and snacks are mostly carbohydrates with little protein and/or fat to slow the carbohydrate down. I think it is reasonable to ask your physician to give you three months to follow the meal plan (carbohydrate counting) and regular physical activity and then repeat your A1c. If it is less than 6.5%, then you don’t need to add medicine.
[Editor’s comment: Please read HbA1c Measurement. In general, people with diabetes use the A1c as a “report card” of how they are maintaining blood sugar control over a two to three month period. Even if you test your blood sugar at 6 a.m., noon and 4 p.m., for example, and see readings of 80 mg/dl [4.4 mmol/L]; 95 mg/dl [5.3 mmol/L]; and 110 mg/dl [6.1 mmol/L], this does not guarantee that you will have a constant average of 95 mg/dl [5.3 mmol/L], or an A1c of 4.8%. In fact, you could be having elevated blood sugars at other times of the day/night when you are not testing your blood sugar, which is why the A1c is considered a better “report card” about one’s diabetes than the average blood sugars obtained on a home glucose meter. You should have your doctor explain this is more detail, if needed.