A1C numbers

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

  1. steingar

    steingar Taxi to Parking

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    Hate to say it, but B.S. it isn't. Diabetes is a threshold disease, involving both genes and environmental factors. A combination of them can put you into the threshold or keep you out. This is in contrast to diseases like CF where you either are or aren't.

    Sorry your answer is so difficult to get at Tom. Folks aren't airplanes, and don't act like them. Folks are complicated, and often poorly described in numeric terms.
     
  2. Rykymus

    Rykymus Line Up and Wait

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    The problem is that the doctors were just following procedure and labeling me as having a "disease", when it was really caused by dietary and lifestyle, which can (and were) changed. They would just rather slap a sticker on my head and put me on a pill, so that they and big pharma could feed their revenue stream. That's not health care, that's business. Like you said, folks are complicated. We aren't "one size fits all". Unfortunately, our industrialized health care system refuses to see that.

    It has taken me years to find a doctor that doesn't play that game. And surprise, he's a senior AME. Brilliant guy, and was one of the original creators of concierge medicine.
     
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  3. bflynn

    bflynn En-Route

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    But like all things, environment can override genes. If you don't believe that, follow this hypothetical.

    Go eat a box of pop-tarts every day for breakfast and a half dozen of Little Debbie cakes in the afternoon. Do this pretty much every day for three months and then go get an A1C test (you can use a store bought one). In addition to probably gaining 30+ lbs, you'll also find your A1C number well above 6.5, no matter what your genes are.

    Diabetes is a disease of too much blood glucose. That can happen through medical issues, such as pancreas and liver problems or it can be as simple as an excessively poor diet. Anything that revs your adrenaline up probably plays a role - stress, danger (real or imagined), excessive excitement - anything. Being overweight is an issue as well since fat cells play a role in insulin suppression.

    The truth about T2 diabetes is - it is largely self inflicted. Exercise + losing weight + a calm lifestyle will all help you overcome it. You can even get to a point where no kind of control is necessary anymore, but you'll still have to lay off the pop-tarts and snacks.
     
  4. neilw2

    neilw2 Line Up and Wait

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    Many of your points are extremely valid. I love that you found a MD that looks at you as a patient and not just a number.

    Just a few criticisms-
    -Metformin is a generic drug. Big Pharma doesn't make anything on generics. Big pharma does get in the way of practicing medicine WAY to much but in this case it's not big pharma
    -The reason your previous MD was putting you on Metformin is because it is one of the only drugs shown to decrease morbidity and mortality in pre-diabetic and diabetic patients. The data is so good and robust treatment guidelines such as the ADA recommend that a patient be starting on it as soon as pre-diabetes is diagnosed.
    -The reason the ADA and other organizations say to start immediately is because of the fact that most patients do not actually modify their lifestyle enough. Your previous MD should have given you a chance to show you could if you requested but he was following guidelines by starting you so soon.

    Most importantly congrats to you on your commitment to a healthier lifestyle!
     
  5. Cooter

    Cooter Pattern Altitude

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    The most fundamental difference is that Type 1 is an autoimmune disease, which is quite different than Type 2. The juvenile label is a holdover from the past and I don't find it used as much anymore.
     
  6. steingar

    steingar Taxi to Parking

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    I am afraid you are quite mistaken, there are strong genetic factors controlling adult-onset diabetes. For example, most in the clan of Steingar are or have been far more obese than even Steingar himself, yet there is no incidence of diabetes or even prediabetic indications. On the other hand. Mrs. Steingar, who no one would call obsese lest they face the wrath of Steingar (or even worse Mrs. Steingar) has had pre diabetic indications in the past. Same diet, yet one on the threshold and one not. Genes. It isn't just a lifestyle choice.

    That said it is true that those who eat a balanced diet, engage in regular exercise, and watch what they eat and how much do tend to stay out of the diabetic threshold than those who don't. But exceptions abound, plenty of lean diabetics and corpulent non-diabetics.
     
  7. Checkout_my_Six

    Checkout_my_Six Final Approach

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    true.....but, just as bad genes are a risk factor, so is being overweight a risk factor for diabetes.

    The problem with diabetes.....it isn't reversible. :(
     
  8. Cooter

    Cooter Pattern Altitude

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    Getting knocked off isn't usually the problem although that can happen. For hockey, I don't think you'd have a problem. It normally tends to fall off after a few days though, so you can get something called Skin TAC from Walgreens and that helps it to stay on longer.
     
  9. Rykymus

    Rykymus Line Up and Wait

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    That was my point. Calling one a diabetic simply because they have a high fasting blood glucose, or high A1C is not an accurate diagnosis. If you have the disease, changing your diet and lifestyle will not cure you. It might give you better numbers, but you still won't be in the normal range because you have a disease. At the time, I was with Kaiser (the poster children for industrialized health care). That doctor never suggested that I lose weight, eat better, and exercise more. It was just "take this pill for the rest of your life."

    These days, I only go to doctors to get tests and images that I can't get without them. I was a paramedic for 12 years, so I have a basic understanding of A&P and pharmacology. I can do the research and diagnose most things myself.

    For what it's worth, I understand why the health care industry is this way. It works for the majority of the patients. (And it is more profitable.) But it is at the expense of the minority. As paying customers, we should all refuse to accept this.
     
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  10. bflynn

    bflynn En-Route

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    Sorry, but this is just flat wrong. Diabetes is a disease characterized by high blood glucose. If you make a diet and lifestyle changes and as a result have normal blood glucose then you are not experiencing diabetes any more and it may never come back. My mother has diabetes because she eats poorly. However, if she eats well, her morning blood glucose reading is in the 90s and her A1C is 5.0. When she eats poorly, it's 150+ / 9.0.

    Stuff your face with junk and you'll experience diabetes. But if the cause is entirely environmental then a solution can entirely "cure" it, which is to say to remove all the effects - you no more have diabetes than anyone else does because everyone can eat junk and pump their blood sugar up and in the US we make that really easy. There are multiple causes and some can be reversed. Some cannot.
     
  11. Rykymus

    Rykymus Line Up and Wait

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    Diabetes: "A disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood and urine."

    What I'm saying is that an increased blood glucose due that is reversed by removing the environmental causes (poor diet, lack of exercise) should be called "hyperglycemia", not "diabetes". One is a disease, the other is the body's natural reaction to external stimulus. "Diabetes" creates problems even without external forces, hence, it's a disease. Hyperglycemia is a condition, which can be the result of diabetes, the result of external forces, or both. But having hyperglycemia does not by itself make one a diabetic. If I eat a box of Twinkies everyday, three times a day, for a week, my blood sugar will be elevated. (And I'll likely be sick as hell.) But when I go back to my usual diet and activity levels, my sugar will normalize again. This is a fairly normal response from the human body. True, if you continue to do this for the long term, you may become a diabetic.

    High blood sugar is a possible symptom, but not proof by itself of any disease state.
     
  12. bflynn

    bflynn En-Route

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    The claim is that someone who once had high blood sugar must be T2 diabetic and labeled forever. High blood sugar is how the diagnosis is made because that is the source of damage from the disease. Absent high blood sugar, there isn't a disease to be identified.

    I was demonstrating that someone can have high blood sugar due to external factors, be labeled diabetic, and actually not have a problem.
     
  13. eaglepilot

    eaglepilot Pre-takeoff checklist

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    Many Thanks

    I'll give it a try.
     
  14. Rushie

    Rushie Pattern Altitude

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    This is correct. right now doctors use the a1c to diagnose and I disagree that that's the best way. It's easier and quicker and maybe cheaper than the better way which was to conduct glucose tolerance tests. To know if you are REALLY diabetic, you need to know your body's response to a carb load over several hours and the BS profile over 24 hours. The a1c is an average. As we all learned in grade school, an average can be had many ways. If you have an average BS of 140, you might have had 135 for 12 hours and 145 for 12 hours. What if you snack and graze all day long? Or you might have had 80 for 12 hours and 200 for 12 hours. This would be impaired glucose tolerance or actual t2 diabetes.

    This is a very simple mathematical truth and I'm appalled medicine has gone to this imprecise and unfair diagnostic tool. While it may be true that for most people the elevated a1c does correspond to true diabetes, there are individuals who simply graze on carbs all day and a couple times at night (!!) keeping their BS hovering at too high an average. Now we can argue whether that's healthy or not but certainly it is not the same thing as having excursions well above 200 after meals.

    If your morning fasting sugar is 100 but your one hour post high carb meal is 139 you do NOT have diabetes and can live with this profile your whole life. If you are a carb grazer but do NOT have the "diabetes genes" you will never get diabetes. But keep your a1c borderline like this you will have to put up with being bothered by your doctor for being "prediabetic" and maybe even put on Metforin- for nothing! I would almost consider it malpractice to put someone on a drug without having done a GTT but that's what we've come to now.

    Having said all that, the consequences of diabetic tissue damage are so horrible that medicine is trying to minimize damage because pulling an a1c out of a patient's arm is a lot easier than convincing them to come in for hours of tolerance testing. I get that. It's for the good of the sheeple.
     
  15. azure

    azure Final Approach

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    While this is true, I wonder whether you're saying that Type 2 DM controlled by diet and exercise isn't true diabetes because changes to environmental influences corrected the abnormal blood sugar. I don't think that's true, because even though someone for whom that kind of control works has normal glucose levels when tested, they still have an abnormal glucose metabolism, and their sugar can still soar if they fall off the wagon, higher and faster than someone that does not have the disease.
    Quite true, and I know this from experience. When I was in the hospital for several days a couple of years ago after an injury, my fasting sugar was elevated enough for a DM diagnosis - 130 to 140, repeatedly. But they did an A1C, which came back at 4.9, proving that the high levels had started recently. Later after I'd recovered, my blood glucose went back to normal. I was never told exactly what they thought was going on, but from what I've read, mine was a classic case of "stress hyperglycemia".
     
  16. bflynn

    bflynn En-Route

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    "Higher and faster" isn't really a standard. Everyone's blood sugar will soar if they eat really bad food. It can also happen from other, temporary conditions - I know someone who had "diabetes" from a UTI.
     
  17. azure

    azure Final Approach

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    Of course, and I wasn't implying otherwise. My point was that someone with true diabetes still has an abnormal metabolism that will manifest if they start returning to their old dietary patterns, even though their fasting glucose tests normal when controlled. Is it not true that such a person will usually get higher elevated blood levels after meals, or elevations that last longer than before they developed the disease?
     
  18. PaulS

    PaulS Final Approach

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    I thought in normal people Blood Sugar (BS) doesn't soar after meals. People with insulin resistance are a different story, their numbers rise well above what a normal response would yield. My interpretation of this is that people with insulin resistance will have a higher a1c because their bs levels run much higher after a meal. If instead of the normal less than 180 a couple of hours after a meal you run much higher, your avg bs level will be higher, which is what a1c measures. It's a numbers game at that point and if you win ( or lose) the game with high a1c, you need to act.

    My understanding is that if the problem isn't too developed, then you can manage it with diet and exercise, but if the problem is bad enough you need medicine.

    I rode a tour de cure ride about 5 years ago, and ended up with several nurses who specialize in diabetes management. We had a great conversation over the many miles we rode together. One of them was critical of caregivers who frame the treatment plan for diabetes in the mode of you better get your BS under control or I'll put you on medicine or insulin. He said this comes across to people as a punishment or failure by the patient for a health condition that many really have no control over. He told me he tells his patients the truth, that when you have BS issues, that more than likely diet and exercise don't work for many people and that medicine will be necessary at some point. Some can stave it off for years, or forever, but many can't. He tells them not to look at the medicine as a punishment, but to look at it as a life saving gift. Something that preserves your organs, prevents nerve damage, and greatly improves your quality of life over the long term.

    I get my numbers checked every 6 months now and have been below the threshold for medicine through diet and exercise. But I've decided that should that method stop working for me, I will go whatever medicine without hesitation to control it should my doc say I need it. I've seen too many people close to me suffering the affects of neuropathy and worse because they didn't take seriously. Not going to happen to me if I can help it.
     
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  19. Rykymus

    Rykymus Line Up and Wait

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    This is sad. This is just perpetuating a dependence. Although many people cannot correct and manage the problem through diet and exercise, EVERYONE should be encouraged to do so, and supported every step of the way, in order to avoid having to take a medicine. The "failure" is in the health care industry, and the government that told us fat was the enemy instead of sugar, because people in power didn't want to admit the truth and hurt their reputation.
     
  20. 1RTK1

    1RTK1 Line Up and Wait

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    jeffythequick, That seems so strange that the judge was even concerned about your DM.
     
  21. Jeffythequick

    Jeffythequick Pre-takeoff checklist

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    The former Mrs. thequick, at the time, wasn't a model of perfect motherhood, and was concerned about our mutual children. What is sad is that the courts are set up to have "winners" and "losers", and to have one of each, each side must paint their opponent as the "worst person on earth."

    That's how the blood sugar control got into the mix.