I’m 45 years old, about 90 pounds overweight. I’ve been steadily watching my blood pressure rise over the last year or two. I had two grandparents (one on each side) who died of diabetes. In addition, since childhood, I’ve always had at least some of the classic indicators: thirst, excessive drinking (not alcohol), etc. So, I’ve always known that it wasn’t a question of if I was going to develop diabetes, but when.
Went for a checkup in early January and the blood work returned an A1C of 8 and was given the bad news that the day had arrived. He put me on meds for the blood pressure (but not for the blood sugar) and told me to come back in a month for another round of blood work and a follow up. I asked him if I need to buy a monitor and check my blood sugar regularly, but he said to hold off on that for a while.
Since then, I’ve pretty much completely altered my diet. I can’t say that I’ve gone completely carb-free, but I have eliminated a significant portion of them from my diet. Went back last week (about five weeks after the first appointment), took off nine pounds (yay me!) and today I got the new A1C number – 6.6.
I’m still new at this whole thing, but I do know that 6.6 is better than 8. I didn’t have the opportunity to discuss this with my doctor (he’s out of the office for a few days with a family emergency), so I don’t really have any context to judge how much of an improvement this is. Is this just marginally better, or is this a whole lot better? Could I conceivably have done better, or is that the best I could have expected in a bit over a month? I have another appointment in two months – could I conceivably get it below 6 by then, or will the gains become incrementally harder at this point?
Also, any advice you can give for a diabetic newbie would be greatly appreciated. I’m still figuring out the ropes.
Thanks,
Zev Steinhardt
(Not really sure if this should be IMHO or GQ. I figured IMHO because I’m asking people’s opinions, but if it should be GQ, please feel free to move it.)
I know that the thinking on what is a good / acceptable level of blood sugar for diabetics has been shifting in recent years, and the concept of “tight control” (which is what doctors wanted us to shoot for ten years ago, when I was first diagnosed) has started to be seen as having its own issues. I imagine that those who know even more about this, like Qadgop, will weigh in here.
ISTR that most endocrinologists like to see their diabetic patients get their A1C numbers to 6.5 or below.
You might not be able to get it a lot lower in 2 months (especially since, as I remember it, A1C is a proxy for average blood sugar over the previous three months), but it is certainly possible for at least some diabetics to get their numbers below 6, typically via diet, weight loss (if overweight), medication, and exercise. I started out at 8.2 on diagnosis, got it down to the low 6s fairly rapidly, and eventually brought it to the low 5s, through medication, diet, and exercise.
The A1c is pretty much a 3 month rolling average of your blood glucose level. Dropping a full point in 3 months is significant; dropping that much in just a month is phenomenal. I’ve done it, but I will regale you with tales of my gall bladder summer from Hell elsewhere.
If you want to try to control it without meds or insulin, you have to limit your diet to lean meat and green veggies, FWIW.
I’m new to this too, 6.2 so I’m doing the lean meat, veggies, little to no bread or carbs route. Down 20 lbs in a month, I wasn’t really heavy but I do feel very ‘nimble’ now. Still experiencing some tingling in the feet so I’d like to get that completely under control. My endocrinologist just put me on Medformin so we’ll see where that takes me.
Did you discuss the possibility of medication? Have you had a Glaucoma screening?
On the other hand, provided you are being competently monitored, and you ARE able to control it by diet and exercise alone, that’s not a bad way to do it. It takes a lot of self-discipline but if you can do it good for you!
As time goes by, no matter how good your diet/exercise program, you might wind up on medication after all - but less than you might have otherwise. The less medication you need to control diabetes the better off you will likely be, because medications have side effects.
So, kudos to you for taking the problem by the throat and wrestling it to the mat. That’s how you keep healthy with diabetes.
ETA: Losing the extra weight will also help, but that will take time.
All this. (I’m an RN and a CDE, BTW). My husband is controlling it with diet and exercise, without being overly strict with it, either - his last A1c was a 6.0. However, he eats carefully five days a week (a bit less so on the weekends) and takes full advantage of the gym at his workplace every single day he works. He is aware, also, that Type 2 Diabetes is a progressive disease, even if you do everything right, and he will probably end up on medication at some future point. This happens. But that doesn’t mean you shouldn’t do all the right things NOW.
My personal feeling is that everyone with a diabetes diagnosis should own a glucometer and know how to use it. Not everyone will agree with this. But there are going to be times - like when you start an exercise routine, or get the stomach flu, or something else changes - that it’s good to know how the situation is affecting your numbers so you can learn how your body acts and adjust accordingly. I’m not saying check all the time necessarily (individual needs differ), but I do think everyone with the diagnosis should check at least occasionally. Just my thoughts…
I got my A1C down from 10.6 to 6.4 in the first five months after my diagnosis. My doctor says that diet and exercise is the #1 medication for diabetes, closely followed by “good ol’ metformin.”
The fact that you’re already down to 6.6 without the help of medication is really, really great news. Keep it up!
Oh, and if you do end up with a glucometer, check Amazon for test strip prices before you buy from a local pharmacy. All the stores in my area charge ludicrous, ludicrous prices.
It’s such great news that I almost wonder if the first test was an error! Not to diminish the results of your efforts - they are really great efforts, and will benefit you in the long run either way - but that’s a huge drop in A1C in a single month. Consider that only, roughly, 1/3 of your red blood cells are the newly made ones in that count; the other 2/3 are the same red blood cells that they tested a month ago, and those didn’t lose their glycated hemoglobin. So if you keep it up, your A1C in another two months could be dead on normal. If you had been testing your blood sugars this past month, it’s quite likely that you were right on target. (And your doctor’s hope that this would be the case may be why he didn’t want you to spend the money on a glucometer and test strips. A highly motivated Type II patient can sometimes fix things through diet and exercise and not need a glucometer at all, or for years.)
When your blood sugar is high at the moment a new hemoglobin molecule is made for a baby red blood cell, it changes the shape of the hemoglobin a little bit. We call that changed hemoglobin a “glycated hemoglobin”. That’s what the A1C is counting - what ratio of your hemoglobins have been glycated. You cannot un-glycate a hemoglobin. Once glycated, it will stay glycated until the red blood cell dies in about 3 months. That’s why the A1C is so cool - it shows us the average blood sugar level indirectly, by seeing how many of your hemoglobins were made wonky by too high blood sugars over the last three months. But that’s also why they usually only do it every 3 months…you’ve got to give those red blood cells time to die off and be replaced with new ones that are hopefully less glycated.
I’m not going to weigh in on when someone should get a glucometer, but it is true that various stresses will affect your blood sugar.
There were two occasions when my spouse wound up getting a couple insulin shots - one was a severe infection, and another was a very stressful event with his terminally ill mother. In both cases he recognized worsening symptoms of “cotton mouth”, urination, thirst, and so one and got himself to a doctor pronto, only to reveal his normally well-controlled blood sugar was way out of whack. Apparently, the body’s response to stress is sometimes to spike blood sugar. Maybe it’s related to the fight-or-flight response? In normal people it makes energy available to combat whatever is causing the stress, in diabetics, because the system isn’t functioning as it should, it throws things out of whack?
Anyhow, he got the insulin, dealt with the triggering problem, and then resumed his normal diet/medication and went back to what is normal for him these days without needing further insulin.
The good thing about diabetes is that it’s almost always controllable. The bad news is that controlling it can be harder than you first suppose.
Good point there!! If it was NOT an error, I wonder if maybe a couple months back your blood sugar was truly insanely high for a bit, enough so that it skewed the average a lot higher (WhyNot can comment on whether that’s even feasible).
6.6 is definitely into the full diabetes diagnosis range. I don’t know at what point they’d want to add medication but if your levels stay around there or perhaps lower, you might be labeled as “controlled with diet and exercise” and not need meds for a bit.
I do know that once you’ve been given the diagnosis, even if you get things down to the nondiabetic range you’re still considered as having diabetes, just well-controlled.
It’s definitely worth keeping it under control - among other things, for economic reasons!! My father-in-law is 8 inches shorter than I am, and weighs nearly as much (I’m just obese, he’s spherical). He spends a fortune on medications - 300+ a month - for the blood sugar. He has had numerous cardiac procedures, almost certainly a result of diabetic damage. He has stage 3 kidney disease. And he still eats badly far too often.
Despite what Mama Zappa says 6.6 is not in the full diabetic range. According to my physician DIL, once you get to a certain age, above 6 is better (you live longer). In addition to her MD degree, she has master’s in public health and biostatistics. Anyway, if you truly dropped from 8 to 6.6 in one month, then your newer blood cells are glycosolated at a level well below that rate.
Here is my story, FWIW. Ten years ago, I had a blood sugar of 8.1 (equivalent to 147 in the US system). I don’t know what my A1C was, but it seems to track the blood sugar pretty closely, so a guess of 8.1 would not be far off. I was put on a low carb (really medium carb) diet and given metformin. This brought both the blood sugar and A1C down to the low 6s. They have continued to fall, as has my weight. The latest were blood sugar 5.7 (= 103 in the American system) and A1C of 5.6. My doctor is quite pleased with these levels, while my DIL thinks they are too low and I ought to stop the metformin. But I don’t want to say to my doctor that “DIL disagrees with you”, and am at a loss over what to do. Neither my DIL nor my doctor wants to measure glucose level. At the point I am at, it is just expensive, slightly painful, and unnecessary.
Although off thread DIL also thinks I am over-medicated on blood pressure pills. A typical reading these days is 115/75, although it has been as high as 130/80 and as low as 105/70. This one I will argue with my doctor on the grounds that the diuretic I take interferes with both sleep (getting up to pee in the middle of the night from which I often don’t get back to sleep) and defecation (it sucks water out of the bowels). Without mentioning my DIL (who has stats to show that at my age 130-140 would be better), I can just give him those arguments.
Change doctors? Hah, there are already hundreds of thousands of people in Montreal who cannot find a GP. And my doctor is clearly winding down his practice, not having accepted any new patient in 20 years. His practice had become part-time and now the province is poised to penalize by 30% any doctor who does not see a certain minimum of patients, this will certainly force him to retire. His practice is now down to 3 1/2 days a week, ending Thursdays at noon. With frequent vacations.
so one reading of 8-something, and another of 6.6, would get you the label.
I hadn’t heard that 6+ is better after a certain age, though I had heard that if you carry an actual diagnosis, docs are happy with anything under 7.
As far as stopping the metformin: I wonder what your blood sugar might be like if you weren’t on it? Since you’ve lost weight, it’s possible you don’t need it any more. Could you discuss with the doc possibly stopping it for a few weeks and then retest? Obviously that wouldn’t be long enough for a valid A1C but it might be enough to test your fasting glucose level, to give you some idea as to whether you need to go back right on the stuff.
