At risk of Diabetes

S

Sugar Daddy

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My employer recently made me go through a physical that was a lot more involved than the Class III for sure. Part of the test was an H1BC test. It came back as 6.0. The doc (not my own doc) said it indicated that I was at risk of diabetes.

I'm fairly slim with just a bit of a belly. Years ago I used to work out a bit, but for lately that's dropped off. I do get up and walk a lot, as well as ride the bike, so I'm not entirely sedentary. I enjoy sweet tea and the occasional sweets (ice cream, candy bar, cookies, etc). Also, I did not fast for this test since I didn't realize they were going to draw blood. Not sure if this made a difference or not.

All this being said... WTF??
 
Your HbA1c is at the upper limit of normal so I would not loose any sleep over this. The higher the A1c the higher the risk for developing diabetes which is also related to obesity. It is important to keep your weight under control. The risk for diabetes starts to increase significantly with BMI (body mass index) over 25. Most people in this country (me included) get way too much sugar in their diets so it would not be a bad idea to reduce the amount of sugar in your diet. Regular exercise may reduce the chance of becoming diabetic.

BMI calculator:http://www.nhlbisupport.com/bmi/

http://www.ncbi.nlm.nih.gov/pubmed/15610327

http://jama.ama-assn.org/content/268/1/63.short
 

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Wait for Bruce for the full, reliable data, but as I understand it, a 6.0 Hb1AC does not by itself create a clinical diagnosis of diabetes. However, as the doc told you, it does indicate that you could become diabetic with not much more metabolic changes, and as my doc told me (I'm not at 6.0 but I'm close), it's a caution sign that you might want to make some dietary and exercise changes as you get older in order to avoid the diagnosis in the future.
 
My employer recently made me go through a physical that was a lot more involved than the Class III for sure. Part of the test was an H1BC test. It came back as 6.0. The doc (not my own doc) said it indicated that I was at risk of diabetes.

I'm fairly slim with just a bit of a belly. Years ago I used to work out a bit, but for lately that's dropped off. I do get up and walk a lot, as well as ride the bike, so I'm not entirely sedentary. I enjoy sweet tea and the occasional sweets (ice cream, candy bar, cookies, etc). Also, I did not fast for this test since I didn't realize they were going to draw blood. Not sure if this made a difference or not.

All this being said... WTF??

Exactly the same thing I'm going thru..... My Dr/AME gave me a one touch meter, and told me to start monitoring my blood sugar, and figure out what was raising my blood sugar, and to quit eating those things. So far I have been able to keep the daily numbers in the mid to upper 90s.
 
Wait for Bruce for the full, reliable data, but as I understand it, a 6.0 Hb1AC does not by itself create a clinical diagnosis of diabetes. However, as the doc told you, it does indicate that you could become diabetic with not much more metabolic changes, and as my doc told me (I'm not at 6.0 but I'm close), it's a caution sign that you might want to make some dietary and exercise changes as you get older in order to avoid the diagnosis in the future.

As I understand it, the better you protect your self now the longer you can put off the diagnosis of type 2

I've found it is the starches that raise my blood sugar. and exercise is what brings it down.

Like Duh. :)
 
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Wait for Bruce for the full, reliable data, but as I understand it, a 6.0 Hb1AC does not by itself create a clinical diagnosis of diabetes. However, as the doc told you, it does indicate that you could become diabetic with not much more metabolic changes, and as my doc told me (I'm not at 6.0 but I'm close), it's a caution sign that you might want to make some dietary and exercise changes as you get older in order to avoid the diagnosis in the future.

The diagnosis of diabetes is based on blood glucose levels. A fasting blood glucose over 126 meets the criteria for diabetes as does a nonfasting glucose over 200. The oral glucose loading test is not used very much anymore.

http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/

Hemoglobin A1c is a measure of average blood glucose levels over the past month or so. It is a useful test for management of diabetes as well as pre-diabetic risk stratification but not for the diagnosis of diabetes. There is also a condition known as impared glucose tolerance or pre-diabetes. People in this catagory should work hard to lower HbA1c to reduce the risk of developing diabetes and to lower cardiovascular risk.

Gary_F
 
My employer recently made me go through a physical that was a lot more involved than the Class III for sure. Part of the test was an H1BC test. It came back as 6.0. The doc (not my own doc) said it indicated that I was at risk of diabetes.

I'm fairly slim with just a bit of a belly. Years ago I used to work out a bit, but for lately that's dropped off. I do get up and walk a lot, as well as ride the bike, so I'm not entirely sedentary. I enjoy sweet tea and the occasional sweets (ice cream, candy bar, cookies, etc). Also, I did not fast for this test since I didn't realize they were going to draw blood. Not sure if this made a difference or not.

All this being said... WTF??

That you caught this early is a very good thing. You're at the stage where improved diet and exercise can definitely delay becoming a full blown diabetic.

Getting some education on what is Diabetes Type II, what is causing the increased blood sugar readings, and what are the complications if you don't make the needed changes would be a very good thing. Taking care of this without medication is totally doable if your A1C is 6.0, but you need to know more about what's pushing that and how to manage it.

Finger tip testing and monitoring (keeping a log) is an excellent idea. But this too requires a bit of education to have the data make sense to you (as in, test at the wrong times and you won't get consistent useable data). Target number on your meter is the 100-115 mark or less.

As far as your medical certification on flying, you're still in the permissable range. It's when you're A1c number gets above 8 that the FAA really has something to say about it.

When I was diagnosed as a Type II in February of last year, my A1c was a screaming 12 :hairraise:. Very much in the danger zone. I was immediately put on medication (Metformin, 1000mg morning/evening). By the time I went into my first medical in Mid May, I was back down to a safer 6.6.

The special isuance for Type II is easy to get, as long as you follow all the guidelines as to what the FAA wants to see, which is mainly the documented lab results, and a doctor's letter saying that you are on the diabetes meds with no bad side effects, you're A1c number is in the range the doctor is satisfied with, and you do not suffer from any damage to neuro, nephro (kidney), cardio, or ophthamologic (eyes).

Dr. Bruce can comment and provide additional guidance on this.


The biggest thing is to take this warning seriously. So many body systems can suffer massive damage due to high blood sugars. Get this under control now and you can live/fly a long and happy life.
 
The diagnosis of diabetes is made on the basis of blood glucose levels with a fasting glucose 126 or higher or occasionally an oral glucose loading test (OGTT). If you have a random glucose over 180 you are also a diabetic. HbA1c can be helpful but is not used to make the diagnosis. The HbA1c level is sort of an average of the blood glucose levels over the past month. Persons with fasting glucose levels between 100 and 125 or mildly elevated HbA1c levels (typically 6.1 to 6.5) usually have impaired glucose tolerance and may be referred to as pre-diabetic. Diabetics and possibly pre-diabetics have an increased risk of developing cardiovascular problems. Proper diet, weight loss and exercise can improve glucose tolerance.

http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/

Here are some recommendations for testing for diabetes.

1. General screening is recommended at 3 year intervals only for those patient populations known to be at high risk. High risk includes one or more of the following: > 45 years of age, has a sibling or parent with diabetes; overweight (BMI > 25 kg/m2); are members of a high-risk ethnic population; have delivered a baby weighing > 9 lbs. or previously diagnosed with GDM, are hypertensive > 140/90 mm Hg in adults); have an HDL cholesterol level <35 mg/dL and/or a triglyceride level > 250 mg/dL; polycystic ovary disease; history of vascular disease; habitual physical inactivity.
2. Patient screening is recommended yearly for previous impaired glucose tolerance (IGT)**; previous impaired fasting glucose (IFG)**; overweight people with one or more other risk factors.
 

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Welcome to aging. We've never been this old before. Sigh.

First of all, it's a Hemoglobin A1c. And GOOD for your employer. It means he'd like to keep you on the job on account of hiring your replacement might be too painful.

It is a very good thing this was caught early. We know in diabetes, that when it's been diagnosed, the illness has been active destroying the bottom ("basement") membrane whereupon all the cells of all the tissues- blood vessels, kidney tubules, GI tract lining, etc....reproduce. That membrane has to breathe and grow replacement cells, continuously. And it's been going on for at least 5 years.

Long term, Diabetes is actually a disease of the "basement membrane" of organs, but we detect it with glucose intolerance. That's how it destroys organs.

"BUT I FEEL FINE!"
Jabut, if you want your 70s to be function, you have to stop the destruction now. It's well known that if your glucose control is good, the progression of the disease gets arrested. Otherwise it result in, "If I knoew I'd live this long, I'd have taken better care of myself...!"

In many labs, 6.0 is out of the normal range. It's 5.8 at two of our three local hospitals.

Fasting made no difference, it represents the 90 day moving average of you diabetic control. SO, LOSE the weight. Start running in the AM. Forestall the need for a oral pill to help control the blood sugar.

WTF? You've never been this old before. Sigh. In the old days when one of our generation died of a heart attack it was usually a complication of undetected diabetic arterial disease. Ever notice, how it rare, that Johnny's daddy drops over dead of a heart attack at 54 and the Mom has to sell the house? That's 'cause we look for it and control it.

The SI for pill controlled diabetes only grounds you for 60 days, and is easy to get. I get 'me on the phone all the time with the correct documentation.

SO, GET Crackin' (!)
 
The health consequences of impaired glucose tolerance begin long before someone meets the criteria for the diagnosis of diabetes. Obesity often results from over-consumption of carbohydrates, especially sugar. The body tries to compensate by increasing insulin levels but the cells gradually become more resistant to the effects of insulin. This leads to damage to blood vessels throughout the body at the cellular level. The definition of diabetes is somewhat arbitrary since the deleterious health consequences begin years before somebody meets the criteria for the disease. Impaired glucose tolerance (diabetes or pre-diabetes) commonly occurs with certain other health problems known as the metabolic syndrome which has a high risk of vascular complications.
http://www.americanheart.org/presenter.jhtml?identifier=4756

The good news is that this process can be significantly delayed or reversed with weight loss, exercise and improved diet. The Mediterranean diet has been shown to be beneficial for this problem.
http://www.usatoday.com/yourlife/food/diet-nutrition/2011-03-13-med-diet_N.htm
http://www.mayoclinic.com/health/mediterranean-diet/CL00011

Tobacco use is always bad for the health but it severely increases the cardiovascular risk for those with pre-diabetes or diabetes.
 
Thanks Doc B. I appreciate the advice. Hopefully I won't have to become a paying recipient of your wisdom.

Gary F, I like the Med Diet that you linked. My favorite part is that it doesn't ban pasta, but rather recommends whole grain pasta. I love pasta!!

Thanks to everyone else as well!

For the record, I'm 5'10" and 157 pounds at my last weighing. In the past, McD's and other similar eateries were my forte. Due to high LDL I've been trying to watch my diet. For the past couple of years, it's been mostly chicken/turkey. Atvorstatin has helped out with the LDL as well. I do have a sweet tooth, especially when I'm hungry. Guess I'll have to avoid getting hungry!! I really don't want to take any more pills. I'd like to zap the Atvorstatin as well if I can.
 
. Also, I did not fast for this test since I didn't realize they were going to draw blood. Not sure if this made a difference or not.

All this being said... WTF??

For the A1C, I doubt it. The way this test works is... sugar products bind to your red blood cells in a permanent fashion, in proportion to the sugar levels in your blood (This is a gross oversimplification, but bear with me). The higher your blood glucose level the greater the amount of binding (or in this instance its referred to as glycosylation). Again, this is a permanent reaction, and lasts for the life of the blood cell.

Red blood cells last about 6 weeks 90 days (thanks Dr B for the correction). Millions die every day and millions are replaced by your bone marrow daily as well.

The A1C measures an average level of glucose control. If your sugar tends to be high on average, more red cells are permanently bound to higher levels of sugar product, and this is reflected on average.

The great thing about this test for surveillance is that you may have a "perfect" blood glucose level when you go to the doctor (by accident or design, fasting, self medicating, eating "right" for the day or two before your lab draw)... but the A1C gives a long term reading on how well glucose is controlled. The only way to lower it is to eat right/medicate properly EVERY DAY.

But that long term trend property is why fasting isn't such a big deal with that particular test.
 
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Good explanation Dave.

A dangerous A1c level was what "busted" me when I was diagnosed. I had done what I thought would have the fasting glucose to a low level for the day of the exam, but the blood draw correctly discovered I was an a road to ruin.

Now I'm under controll and much better because of it.


Since I've always enjoyed learning "how things work", can anyone share how the lab test works to determine the A1c number? I know it's not like they sit there and actually count the red blood cells. Is it similar to the fingertip test where the amount of voltage acrcoss the contacts is measured and converted into a number that makes sense?
 
Something else for Sugar Daddy's benefit.

I have made use of the Bayer brand home test kits for HbA1c. And while no substitute for an official one performed by your doctor's office, the results from the home tests have been close enough to the real blood draw for me to conclude it's useful for home monitoring. Sorta like using a home blood pressure cuff can monitor that.

The kits can be found in most pharmacies for about $30.00 and includes 2 tests.

Again, for home monitoring only. For me, it was providing encouragement that once I had started on medication and treatment, I was progressing from the initial very scary (12+%) level to the level that the FAA was going to be happy with.
 
Continuing to cover this base for Sugar Daddy's and others benefit, here is something I found on "www.diabetes.com" when I did a google search for "how is the A1c test done".

"The tests you do at home show your blood sugar level at that moment. The A1C test shows your average blood sugar level over the past two or three months. It's the best way to see how well your type 2 diabetes is controlled.

It usually takes two to three months to see changes in your A1C. So, you may get this test two to four times a year, depending on how well your treatment is working. The A1C blood test is usually done at your doctor's office.

The American Association of Clinical Endocrinologists (AACE) recommends that people with type 2 diabetes reach an A1C goal of 6.5% or less. Reaching this goal is important, since every 1% increase above 6% raises your risk for diabetes complications (see list below). You and your doctor will set a goal that's right for you. If your levels rise above your personal goal, you may need to change your diabetes medicine, or add new medicine and review your Treatment Plan.

The chart below shows how an average daily blood sugar number might compare to an A1C number. (Note that these blood sugar numbers are for tests done in a lab. If you test your blood sugar at home, your numbers may be a little lower.) "

bloodsugarcontrol.gif


-----------------------------

Good blood sugar control can reduce your risk of serious health complications from type 2 diabetes, like:

Heart disease and stroke. Adults with type 2 diabetes are more likely to have heart disease or a stroke. Heart disease is the leading cause of death in people with diabetes.

High blood pressure. Many adults with diabetes have high blood pressure or take prescription medicine(s) for high blood pressure.

Eye problems. People with diabetes are at risk for cataracts, glaucoma, and problems with the retina (retinopathy), which can reduce vision or cause blindness. Diabetes is the leading cause of new cases of blindness in adults ages 20 to 74.

Kidney damage. Diabetes is the leading cause of severe kidney disease.

Nerve damage. Many people with diabetes have some nerve damage. This shows up as numbness or tingling in the feet or hands. You may not feel pain well, so sores can get worse and get infected. Severe nerve damage in people with diabetes is a major cause of leg and foot amputations.

Infections. People with diabetes may be at greater risk for infection and death from infections. High blood sugar may make it harder for your body to fight infections. People with diabetes may be at a greater risk for getting many other illnesses. Once they get these illnesses, they have more trouble getting better.

Gum disease. Because infections are harder to fight, you’re more likely to develop gum disease.

Problems in pregnancy. Diabetes that isn’t managed well, before pregnancy and during pregnancy, can cause birth defects and miscarriages. During the later parts of pregnancy, poorly controlled diabetes can lead to very large babies, which is risky for both mother and child.
 
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For the record, I'm 5'10" and 157 pounds at my last weighing. In the past, McD's and other similar eateries were my forte. Due to high LDL I've been trying to watch my diet. For the past couple of years, it's been mostly chicken/turkey. Atvorstatin has helped out with the LDL as well. I do have a sweet tooth, especially when I'm hungry. Guess I'll have to avoid getting hungry!! I really don't want to take any more pills. I'd like to zap the Atvorstatin as well if I can.
Well you are certainly not obese so we can't blame that. If I had to guess I would say that you were careless in choosing your parents. The good news is that your risk of developing diabetes is less than if you were overweight.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1492588/figure/fig3/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1492588/
 
Mike F, when red cells are manufactured the hemoglobin is glycosylated by an enzyme. The more sugar is around, the higher the percentage of the hemoglobin becomes glycohemoglobin. Since the RBC lasts 90 days, the population of hemoglobin vs. Glycohemoglobin becomes the 90 day moving average.
 
RBCs normally last 100 to 120 days and they are being destroyed and replaced continuously. Newer RBCs will reflect the more recent glucose levels. Assuming constant turnover the A1c will approximate the glucose levels over the average lifespan of the RBC. Since the RBC lifespan is somewhat variable it the A1c could be a little biased to more recent glucose levels. In any case we are splitting hairs here. Suffice it to say that elevated A1c levels are bad and it will take a while for subsequent tests to reflect changes in glucose control. I would usually check HbA1c at 3 to 12 month intervals depending on the circumstances. Most of my diabetic patients recorded fingerstick glucose readings, the A1c kept them honest.
 
Bruce and Gary; thanks... but that I kinda knew. What I was asking was the mechanics of the test. I guess its a very high tech bit of equipment that uses....? Chemicals? Electro-something?
 
A quick googlefu of "hba1c test reagent" gives some links that help. A couple give differing versions of the following: a sample of whole or capillary blood is taken. The RBC's are lysed to release the heme molecules where they bind to a dry resin reagent. Once the sample is prepped on the reagent, then the test strip is illuminated by a specific wavelength(s) LED, and the reflectance measured by an optical sensor. Its essentially a fancy, computer controlled version of a colorimetric test strip.

Your fingerstick glucometer I believe measures electrical conductivity through a sample to give you your fingerstick BGL reading.
 
Dr. Bruce,

I've seen you mention this more than once. What's the big difference between running on the morning and running at any other time?
There's not a lot of science to it but it is thought that you are still catabolic in the AM (assuming nighttime lack of eating).
 
Lot's of good info Aggie and Gary.

Sounds like if I start behaving my Hb1ac will probably drop to something not quite as disturbing after 3-4 months. Of course, I'll need to keep behaving, but hopefully the occasional indiscretion might not hurt so much.
 
As long as you remember it can no longer be habitual, that just made Krispy Kreme can still be a nice reward. But just one.

often just half. more fun to share.
 
Been almost 7 years since my OP.

Just got the latest lab results from my doc. My HbA1C is now at 5.7. I'm still in the 155-160 weight range and haven't shrunk.

I guess my diet is working slowly but surely.
 
Been almost 7 years since my OP.

Just got the latest lab results from my doc. My HbA1C is now at 5.7. I'm still in the 155-160 weight range and haven't shrunk.

I guess my diet is working slowly but surely.

Nice job!
 
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