Monday, November 28, 2011

The A1c as a Diagnostic Tool

Although the medical establishment is increasingly leaning toward using it, the A1c is a LOUSY test for diagnosis. It can vary a lot among different people, because some people glycate more and some glycate less. When I was diagnosable by current standards, with FBGs of 138 and 131 three months apart, my A1c was a glorious 4.8. Even when I was miserably symptomatic, and the docs could no longer deny the diagnosis, I had a 7.1, which would, now, be diagnosable (the cutoff is 6.5), but did not reflect how very sick I was. And the top-off is that when I was near death from a coma last year, my A1c was 10.7, which is supposed to equate to an average BG of about 250. NO FRICKIN' WAY! I was actually running between 400 and 600 for MONTHS before I finally collapsed.

It's clear from these results that I'm a low glycator. Maybe being a low glycator means I'm resistant to complications, too (I HOPE), but living with constant thirst, constant hunger, and needing to pee all the time is NOT quality of life. And I have not read any evidence that I actually AM resistant to complications, so why take the chance? I'm aiming for an A1c in the 5's, even though my PCP's APN told me that below 6 is dangerous for us older people. I know my body better than she does.

Then, on the other hand, there are high glycators, who do their darndest, and still can't get below that magic 7.0. Again, I don't know if they are more prone to complications (and again, I HOPE not!), but in NO way should they compare themselves to me. It's not fair, and it only makes them feel bad. And in my case, if I didn't know better, it could lead to undue complacency. Neither one is a good place to be.

So, having no voice, there is nothing I can do about it, but seems to me like if there is ANY suspicion of diabetes in the family, especially Type 2, then a person should INSIST on an Oral Glucose Tolerance Test -- that's the only REAL way to know if you have disordered glucose metabolism. Yes, it's more of a hassle for both the doc and the patient, but it's better to know the truth early. No one WANTS to have diabetes, but if you do, you do, and it's better to learn to take care of yourself BEFORE those complications set in!

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