A friend at racketball has lost weight and plays a lot of racketball. He is diabetic and self administers a shot every day.
He went to the doc yesterday and said he had a 9.3 number. What does that mean and is it dangerous? Another guy at racketball said that is very dangerous and portents amputations.
Is it?
Assuming that’s his A1c number, that is not good. Normal is 5 or so and sorta controlled diabetes is 7, according to some doctors. See here.
9.3 is probably his A1c reading. In simple terms, your A1c is an average blood glucose reading over 2-3 months. Non-diabetics have A1cs around 5.0, which roughly corresponds to an average blood glucose reading of 100 or so; 9.3 corresponds to about 220 (I’m using this site for the conversions)
And yeah, that’s high. Most docs recommend an A1c of 6.8 or below for an adult diabetic. Once you get higher than that, your risk of kidney damage, amputations, and eye damage go way up. If I were your friend, I’m be pretty damn scared.
To put it in perspective, if I ever see a number over 200, I get very concerned. If it’s over 200 and I haven’t eaten anything carby recently, I get panicky. To have an average reading of 220 probably means that he’s spiking quite a bit higher at times.
You say he’s taking one shot a day - that seems low. A modern treatment regime typically involves 4-6 shots a day. Older types of Insulin required fewer shots, but those are the ones where you have to live a very regimented life - the shot had to be at a certain time of the day, and you had to eat at certain times of the day or you risked going low (which is more dangerous than high blood glucose. Go too low, you can die. You can die from high blood sugars, too, but typically it’s not a quick death.)
A1C is a check for something called glycated hemoglobin.
Wait, let’s back up a minute.
Inside your blood cells is a molecule called hemoglobin. Hemoglobin is what oxygen sticks to so that your blood can carry it around to the cells of your body. Think of it, if you like, as a magnet which oxygen is attracted to.
When your body is making blood, it also has to make hemoglobin. Other things besides oxygen can stick to hemoglobin, and one of those things is glucose - sugar in the blood. Those particular molecules of hemoglobin which are a little differently shaped because they have glucose molecules stuck to them are called glycated hemoglobin.
We *all *have glycated hemoglobin in our bodies, because we all have some glucose in our blood which sticks to some of the hemoglobin molecules. A person who has a lot of glucose in their blood will have more glycated hemoglobin than a person with less glucose in their blood. Make sense? If you have more glucoses, more of the hemoglobins will pick them up and be glycated hemoglobins.
Once a hemoglobin is glyconated - once it has a sugar stuck to it - the sugar won’t fall off. It stays glyconated until the blood cell dies. So if we measure the percentage of your hemoglobin molecules which are glyconated, we get a pretty good idea of how much glucose has been in your blood over the last 90 days or so, while those hemoglobins were being put together and getting stuck to glucose in your blood.
The A1c test measures the percentage of glyconated hemoglobins in your blood. A high number indicates that your blood has been high in glucose over the last 3 months.
9.3 isn’t crazy record setting high, or even indication for immediate alarm. It is, however, an indication that the patient might need to be taught to take his blood sugar more often, might need to take insulin more often, and should probably review how exercise is likely to affect his need for insulin. It lets his doctors know that his diabetes isn’t under good control with his current diet, exercise and insulin regimen.
One number alone also doesn’t tell us his pattern. If his last A1c was 12, and now it’s 9.3, that’s actually good news! It means that his diabetes is more under control than it was six months ago. It still needs some attention to be where we’d like it, though.
A1c has been a boon in diabetes management and care, mostly because patients can’t lie - to us, or themselves. They can’t say, “but I test my blood sugar four times a day and it’s ALWAYS normal!” because that’s just impossible with an elevated A1c. And the first and most important step of diabetes management is to stop denying that there’s a problem.
He seemed pretty depressed when he got the readings from the doc. He is 62. We play racketball 10 to 12 hours a week. He is not thin, but not obese either, 5 ft 10 about 210 lbs.
I don’t blame him being depressed. 9.3 is solidly in the range where your risk of bad complications go up.
Did he say what he/his doctor are planning on doing about it? There are a LOT of resources and therapies available for diabetics nowadays. If he’s sufficiently motivated, there’s a good chance he can get things under control, and almost all diabetes-related complications are partially or wholly reversible if you get your blood sugar in check.
Though 9.3 is not incredibly super high, I completely disagree that it’s not an indication for immediate alarm. Sure, he’s not going to drop dead from that right now, but he very much risks kidney problems, eye problem, nerve issues, etc. Immediate alarm is an appropriate reaction IMO, unless, as you mention, it used to be higher and he’s working at bringing it down.
Assuming we’re talking Type 1 (which it sounds like based on shots and the A1c), thin/obese doesn’t have much to do with things. Type 1 means you pancreas stopped producing insulin; it can’t be controlled via diet, exercise, or weight loss.
One thing to watch out for - since your profile says Michigan you’re almost certainly right that it was A1C, but if he happens to have a Canadian blood glucose meter (or his glucose for whatever reason was reported using whatever units we use) it could be his blood glucose. We use different units for blood glucose level than you guys, and approximately 4 to 11 (exact normal range depends on who you ask) is normal.
That’s not quite right. Multiply by 18 to get the US equivalent and 11 x 18 = 198, which is very high. This factor of 18 comes about as follows. In Canada (and I think in the rest of the world), blood sugar is measured in mmol/l (milli-moles per liter), while in the US, it is in mg/dl (deciliter). Given that the molecular weight of glucose is 180, you get the factor 18. Anything above 7 is considered diabetes. Then there is the A1C, which measures the percentage of hemoglobin that is compounded with glucose (glycosolated). My doctor does both because he says that it changes quite slowly and clues him in to patients who have dieted for a week before the blood test. My latest numbers were 5.8% A1C and 6.1 mmol/l blood sugar. That’s about 110 mg/dl, not great but acceptable. My doctor treats me with metformin, which as a side effect, causes some weight loss. Insulin, on the other hand, generally leads to weight gain. I sure wish I had a principled explanation for why this should be, but I suspect there is more to weight than just calories.
The idea is that it’s a hormone used in the digestive process, and having extra floating around promotes weight gain.
However, it’s contested; the folks at Joslin Diabetes Center told me there’s no real evidence that Insulin causes weight gain. Rather, people with out-of-control blood sugar get used to eating everything in sight because they’re pissing out most of their calories and losing weight regardless of how much they eat. When they get their blood sugars in control, they need to also stop eating so damn much, because they’re actually digesting their food now. Otherwise, they gain weight (and often blame it on the Insulin).
At least, that’s what they told me.
And just because no good General Questions thread is complete without some anecdotal evidence, I’ll offer some. After losing nearly 20 pound pre-diagnosis, I’ve gained back maybe 5-7 pounds in the past 2+ years since I got everything under control. And I can tell you, it has nothing to do with Insulin, and everything to do with how much food I put in my mouth. As long as I stay on a reasonable diet, I don’t gain.
(And, just to clarify, this is all Type 1 stuff. Type 2 is the one typically associated with extra weight.)
Obesity can certainly be a factor in causing diabetes, but it’s not the only thing involved. You can be quite thin and still have diabetes.
Your blood cells have insulin receptors on them. When you get overweight, the fat can clog up those insulin receptors. Your blood sugar rises and the insulin producing cells in your pancreas get overworked trying to compensate for it. You end up being insulin deficient, which is basically type II diabetes.
You could also be insulin deficient just to start with (type I diabetes). There are a lot of things that cause this, but you don’t have to be overweight. A lot of people are just born with type I diabetes and are diagnosed with it as a child.
(ETA) You could also just have defective insulin receptors. Some people are genetically disposed to have fewer working insulin receptors, which makes them naturally insulin resistant. Depending on how poorly their insulin receptors work, they could be diabetic naturally or could just be much more prone to diabetes caused by fat clogging up their fewer insulin receptors,
Even if your diabetes was caused by being overweight, all that stress on the insulin producing cells in your pancreas can destroy some of those cells. When that happens, even after you lose weight and stop the fat from blocking the insulin receptors in your blood cells, your pancreas can still end up not being able to produce enough insulin. The insulin producing cells in your pancreas do not regenerate. Once they are gone, they are gone for good. So even if you weren’t born with diabetes and only contracted it by being overweight, you can end up with permanent damage and be on insulin shots for the rest of your life.
If you have type II diabetes caused by being overweight and you catch it early enough, you can lose the weight before you do too much damage to your pancreas, and then as long as you eat healthy you can basically be “cured”. I wouldn’t say it’s a true cure though since you still have some damage to your pancreas, but some people who lose weight don’t have to be on medicine or take insulin shots.
Diabetes is a pretty nasty disease. All that excess sugar starts eating away at your nerve bundles and causes damage to your eyes and kidneys, among other things.
Yep, that’s true of not only type I diabetes but type II as well. One of the symptoms of diabetes is weight loss. You’ve already discussed type I, but it is common with type II diabetes as well. If you have been heavy for a long time and start to lose weight without changing your diet or exercising, it could be because the cells in your pancreas have started to fail and your blood sugar is rising. Your body goes into kind of a panic mode about the excess sugar and it gets filtered off by the kidneys and you pee it out.
Once you get your blood sugar under control, you won’t be peeing out the excess any more. Insulin and other meds to control blood sugar (metformin, etc) therefore often appear to cause weight gain.
Note - IANAD, but I have type II diabetes which I have controlled by losing weight and watching my diet.
Just a nitpick: metformin is one of the few diabetes mellitus medications actually shown to cause weight loss in some people, versus the weight gain seen with other classes. Also, just to complicate things, there is also diabetes mellitus type 1.5, which is a combination of insulin resistance plus decreased insulin production. It is seen in patients who are type II, but who also produce ketones when they get super high glucose. DM is complicated!
Interesting. I won’t argue, but I’m quite sure I was told way back when that 4-11 was normal. Maybe whoever told me had strange ideas about what normal blood glucose is. I have type 2 diabetes and take metformin. All my A1Cs over the past quite a few years except for the very first when I was diagnosed have been OK, so I assume I’m not in too bad shape. I am getting a physical next month, so I’ll ask my doctor then.
5’10" and 210 is obese. that’s a BMI of 30.2 anything over 30 is obese. Is his doctor an diabetic specialist? if not, he should find one who is.
I’ve been type one since 1993. Over here in Europe I have always been told the target range is between four and nine.
It depends on whether you’re talking about fasting levels. For fasting, anything over 7 mmol/L is considered diabetes and anything over 5.6 mmol/L is considered impaired fasting glycaemia (basically pre-diabetes) by the American Diabetic Association guidelines.
However if a non-diabetic person has just drunk a couple of pints of lucozade, their glucose is going to rise - the insulin response is fast, but not instantaneous. The person who told you 4 - 11 mmol/L is normal probably meant for random, not fasted levels. However, 11 mmol/L is still pretty high and unless the person had recently eaten some very high sugar food, would be cause for concern.
Ah yes, I should have mentioned that my levels were fasting. My doctor says my insulin production is high, too high, and I clearly have insulin resistance. Although there was an explanation why insulin causes weight gain, there was still none why metformin causes weight loss. Perhaps, since it lowers insulin levels, some of the carbs do get pissed away. It still illustrates the fact that there is more to weight than just the number of calories consumed. Maybe not a lot more, but more.
My wild-ass guess would be that the most common side effect is gastrointestinal upset, including vomiting, diarrhea, and nausea. I’m sure there’s probably something else to it, though.
Yeah, but that goes away after (at most) 2-4 weeks for most people. It rarely lasts beyond that, and for people who it does last longer, they pretty much move to a different med. It’s no fun.