A1C numbers

Discussion in 'Medical Topics' started by Tom-D, Oct 13, 2016.

  1. Tom-D

    Tom-D Taxi to Parking

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    Google it and all you get are a bunch of medical advertisements.

    How high can the numbers be before they are a hazard to your health?

    6.5 on metformin is as high as the FAA will allow to fly
     
  2. deonb

    deonb Pattern Altitude PoA Supporter

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    On the last one I did, the 'standard range' on the report is listed as:

    4.0% - 5.6%
     
  3. rk911

    rk911 Pre-takeoff checklist

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    taking the FAA out of this for a moment most docs will want their diabetic patients to have an A1C of 7 or less. "normal" range as Deonb wrote is 4.0-5.6.

    if I'm reading govertmenese correctly, a diabetic's fist 3rd class is always special issuance. after that the AME may re-issue as long as the A1C is less than 9 (plus other conditions but the OP specifically asked about A1C). https://www.faa.gov/about/office_or...m/ame/guide/special_iss/all_classes/diabetes/
     
  4. neilw2

    neilw2 Line Up and Wait

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    A healthy patient without a previous diabetes diagnosis should have a A1c under 6.

    A diabetic patient's goal varies from 6.5 or 7 depending on age, risk factors, and what set of guidelines the provider ascribes to.
     
  5. mulligan

    mulligan Cleared for Takeoff

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    FAA will allow 3rd class SI up to 9.0. Will require yearly A1C so while over the age of 40 normally a 2 year certificate is issued but a not valid after date is added for 1 yr where just the A1C has to be submitted to the AME or directly to Oklahoma for a quick reissuance.

    The first SI I believe is 5 years to make sure that you have a 5 year history of compliance but not sure what happens after that.
     
  6. flyingron

    flyingron Touchdown! Greaser! PoA Supporter

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    Dr. Bruce will tell you that every minute you spend with an elevated A1c is damaging (irreparably) your internal organs. 6.5 is NOT a good number to be at. As pointed out, insulin dependent diabetics are lucky to be under 7, but they have bad long term prognosis still. My had all the complications: retinal, kidneys, lost a leg, etc... He's much better now that he got a kidney-pancreas transplant a few years back, but still disabled/
     
  7. Cooter

    Cooter Pattern Altitude

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    I doubt you will find any endocrinologist who would say 6.5 is a bad number for a diabetic(insulin dependent). There is more to consider than just the A1C, it's also how you achieve it. For someone who can keep a relatively steady blood sugar level and achieve a 6.5, any damage that occurs would be minimal unless it's due to negligence in some other fashion.
     
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  8. Checkout_my_Six

    Checkout_my_Six Final Approach

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    Tom....you're gonna die. Probably not today though. :D


    btw...I was a 6.1 and told I was "pre-Diabetic"

    weight loss and diet control usually fixes that....
     
  9. neilw2

    neilw2 Line Up and Wait

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    Yep....there is actually evidence that aiming for lower puts a diabetic patient at too high of a risk for hypoglycemia-which could kill somebody a whole lot quicker than chronic diabetes. Although uncontrolled diabetes will eventually kill you as well.


    agreed...best medicine is definitely never to get close that point of being a diabetic.
     
  10. Rykymus

    Rykymus Line Up and Wait

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    I got the "pre-diabetic" tag as well. They wanted to put me on metformin, but I refused, choosing diet and exercise instead. Got down from 6.4 to 5.4 within 25lbs and 6 months. Unfortunately, once you get that "pre-diabetic" tag, you're apparently stuck with it. It's BS, really, as the number at which they apply that tag varies from decade to decade. I've got 25 more lbs to go, but the first 25 not only brought my A1c down, it also reduced my blood pressure med dosage by 75%.

    I still have 2 more years to go on my 5 year annual reporting requirement for my SI. I don't care about PBOR2. I had to fight hard to get my 3rd Class SI, and I plan on keeping it.
     
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  11. PaulS

    PaulS Final Approach

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    Pretty sure the number is 5.7 or less for a non diabetic at least per my doc and lab. My mom had type II, the issue as I understand it is that once you have diabetes striving for under 6 using meds can cause you to crash, low blood sugar, which can be dangerous. That's my understanding, and consider it's value the same as you paid for it. Best thing to do is make an appointment and talk to your doctor.
     
  12. Jeffythequick

    Jeffythequick Pre-takeoff checklist

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    I had a 6.1% and my endocrinologist said, "Awesome!"

    But I'm T1 Diabetic since 1971, just before my 3rd Birthday.

    I'm working to get it in the 5-6% range. Ride the bike to work, even when there's a storm coming in...

    For those wondering if Insulin Dependent Diabetes is SI, it's actually prohibited per 14CFR67.113, 213, and 313, so anything that you get is SI.
     
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  13. flyingron

    flyingron Touchdown! Greaser! PoA Supporter

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    Did you even read my post? I didn't say that 6.5 was a bad number for Type I's, it's very good control. But you're deluded if you think that the 6.5 diabetic is not going to have future problems. In fact, the endocrinologists have been decreasing what they consider an acceptable number steadily over the years. It's gone from 8 to 7 to NOW 6.5. That's a MAXIMUM, not a target in their mind.
     
  14. neilw2

    neilw2 Line Up and Wait

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    Ron,

    You are incorrect that 6.5 is not a target. 6.5 is the MOST aggressive a1c goal using the most aggressive treatment guideline (Most other guidelines goal is 7) for Type 2 diabetic patients.

    According to all standards of practice if you are at 6.5 (or 7 for many practitioners) for a diabetic patient you are considered in good control and at general low risk for diabetic complications.

    Like you said being a diabetic in general causes increase risk of many diseases, however being well controlled lowers the risk considerably.
     
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  15. neilw2

    neilw2 Line Up and Wait

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    And just to prove i'm not full of it here is the ACP guidelines on diabetic treatment goals:

    source: http://annals.org/article.aspx?articleid=1033354

    And the ADA guidelines:

    [​IMG]
     
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  16. Tom-D

    Tom-D Taxi to Parking

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    I wished that some one had read my post and understood the question and answered it.. To hell with what the FAA wants or allows, at what point does the A1C number indicate a dangerous condition?
     
  17. Checkout_my_Six

    Checkout_my_Six Final Approach

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    did you read anything anyone said?....lol
     
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  18. Tom-D

    Tom-D Taxi to Parking

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    I certainly did and found that you certainly didn't answer the question.
    nice to know the normal range .. but ... the question is at what point does it become a danger?
     
  19. Tom-D

    Tom-D Taxi to Parking

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    no one has answered the question in my post yet specially you.
     
  20. Checkout_my_Six

    Checkout_my_Six Final Approach

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    what about post #15? :lol:
     
  21. Cooter

    Cooter Pattern Altitude

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    Tom, I don't think it is easy to say exactly. The answer is, it depends. Anything above a 7 could be cause for concern if you take no steps to control it and don't monitor it because it probably won't stay at that level. But how much concern is determined by your age and other health factors. You can see the guidelines posted above and they give you a rough idea. If you are diabetic and manage it consistently below 7, I think any damage would be very minimal. Staying fit and maintaining good hygiene go a long way in reducing complications.
     
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  22. Cooter

    Cooter Pattern Altitude

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    It also depends on what you mean by danger. Danger next week, danger next year, or danger in 20yrs? The body is very resilient and can handle short term deviations. Prolonged periods of poor management take their toll even though the symptoms don't necessarily appear quickly.
     
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  23. PaulS

    PaulS Final Approach

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    Ask your doctor, there are variables between labs which could make different numbers considered too high. Also you don't tell us what your situation is, which also affects what is dangerous to your health. Finally, we are a bunch of morons on an internet forum, you'd have to be f'd in the head to take our medical advice over your doctor's.
     
  24. Tom-D

    Tom-D Taxi to Parking

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    the appointment is 31 oct. are you really calling Doc Bruce a moron?
     
  25. PaulS

    PaulS Final Approach

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    Nope Dr Bruce is a smart guy who generally doesn't give medical advice over the internet. If you search here or at aopa you'll find he actually talks a lot about blood sugar. I know from experience with older relatives that there are different recommendations for bs numbers based on whether you are on medication or not and probably other factors. If you are worried get it under control per your doctor who will tell you what's good for you. If you don't trust your doc find one you do. Oh, and high blood sugar will make you feel like crap and act not so nice to people trying to help you on the internet.;)
     
    Last edited: Oct 14, 2016
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  26. Checkout_my_Six

    Checkout_my_Six Final Approach

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  27. PaulS

    PaulS Final Approach

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    Lol, must've been low blood sugar in the morning.
     
  28. Jeffythequick

    Jeffythequick Pre-takeoff checklist

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    I was involved with a study in the 1980's that was cancelled early because of the numbers that came back where those that were tightly controlled had markedly better results than the loosely controlled group.

    However, I didn't become tightly controlled until the late 1990's, when a judge said to me, "If you want to have custody of your children, you better control your diabetes."

    My next stop was Walgreens and I bought my last blood checker. (The endocrinologists and blood checker people give them away like... ummm... candy at halloween.)

    Got custody of the kids (ex-wife and I agreed to it) 6 weeks later.

    Flash forward 20 years, I've had diabetes for now 45 years, and here are my complications:
    very slight retinopathy (can see fine, and my ophthalmologist had to look twice to see it)

    Here are some of the things I do:
    Follow the rules for flying for flying (Check 30 minutes prior to departure, if low, pop a couple of glucose pills)
    Use a Continuous Glucose Monitor (more data = wiser decisions)
    Exercise away high blood sugars (vs. pumping insulin) 30 minutes on the treadmill + 1/2 recommended dosage > pumping insulin and getting fat(ter)
    Look at all food as a combination of carbs (insulin needed), fat, and protein vs. projected exercise vs. insulin on board (a continuous Calculus in my head)

    I've also contacted my Congressman to change the rules for IDDM flying. The current prohibition is from 1949, when a diabetic's choices were to submit a blood sample and have it checked vs. now with continuous glucose monitors that have at most, a 5 minute lag for blood sugars, and the FDA has a proposal to allow dosing based on CGM numbers. Those stupid color matching blood test strips were a nightmare...

    I guess when it comes down to it, I think the risk of complications is to keep blood sugar in the normal range. What is normal? I think testing your non-diabetic family members is a good start. Mrs. thequick ranges from 75 to 85 fasting. The floor of 100 for flying is to account for variation in the testing and a safety cushion.

    As for A1c, I'm shooting for 5.0, with one huge caveat: No low blood sugars.
     
  29. Tom-D

    Tom-D Taxi to Parking

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    I ask a simple question here and now you have me not trusting my Dr.
     
  30. Checkout_my_Six

    Checkout_my_Six Final Approach

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    what did your doc say?
     
  31. Tom-D

    Tom-D Taxi to Parking

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    Did you understand the appointment was 31 oct?

    And for those who believe this is about me, nope, I have my sugar under control.
     
  32. PaulS

    PaulS Final Approach

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    Yawn, you are just looking for an argument, and you are doing a terrible, terrible job at it, step up your game.
     
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  33. neilw2

    neilw2 Line Up and Wait

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    Tom, I think a few of us answered your question the best we could. As a pharmacist- I have had a lot of experience in treating and helping manage diabetic patient's medications to achieve their prescribed goals. As we said the best we can offer as far as how low it should be is based on evidence based guidelines- which seem to arrive at the 6.5-7 range. Every patient is different and while there are some excellent patients who take an active role in managing their disease like @Jeffythequick and can achieve impressive results most patients do not have the dedication that is required to get it as low as 5.0 WITHOUT HYPOGLYCEMIC COMPLICATIONS.

    Best treatment is honestly loosing weight, keeping it off, eating good healthy food, limiting sugars and carbs, and exercise. Those are better than any medicine I could give you. Unfortunately when people don't chose to do that is when my job becomes a whole lot more important.

    If you have any more specific questions and give us more information I would be willing to help further. However, as others have said, the best resource to help this individual patient would be the treating doctor, endocrinologist, nurse, pharmacist, or combination thereof.
     
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  34. Tom-D

    Tom-D Taxi to Parking

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    6.5 to 7 is a good enough answer .
     
  35. Checkout_my_Six

    Checkout_my_Six Final Approach

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  36. Tom-D

    Tom-D Taxi to Parking

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    I don't see the correlation between A1C numbers and the need for depends
     
  37. Jeffythequick

    Jeffythequick Pre-takeoff checklist

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    Thank you for the kind words, but it was kind of like an alcoholic. I had to hit rock bottom before I changed, and that was in that courtroom. The judge just pretty much said, like I was an idiot, "dude, you're going to die with this disease, sooner or later. It's up to you whether it is sooner or later."
     
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  38. Jeffythequick

    Jeffythequick Pre-takeoff checklist

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    If your blood sugar is high, you drink more liquids, and need them, especially at 4500 feet.
     
  39. Checkout_my_Six

    Checkout_my_Six Final Approach

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    Give it more time bro....:D
     
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  40. PaulS

    PaulS Final Approach

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    What scares me most about uncontrolled diabetes is that it doesn't kill you right away. Chances are you will end up with many years of severe pain/ discomfort, followed by limb loss, or stroke or heart disease. I have a friend who has been nonchalant about his type II for 20 years. Now he has neuropathy which affects his feet. He can tolerate it during the day, but at night he says it is unbearable to the point he has been begging for pain killers. He still hasn't really made the correlation between controlling his blood sugar and these consequences.
     
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