a1c and blood sugars

The Numbers That Drive Our Diabetes Management

David Mendosa Health Guide September 22, 2012
  • Dr. Tim Reid once asked me why I was so driven by numbers. I had just spoken at a meeting of diabetes professionals about my success in bringing my weight down from 312 pounds and a Body Mass Index (BMI) of 39.5 in February 2006 to 156 pounds and a BMI of 19.8 in May 2008.

     

    Dr. Reid treats patients at the Mercy Diabetes Center in Janesville, Wisconsin. He also serves as the chairman of the Department of Family Practice for Mercy Health System.

    At the meeting, I also had told him and the other members of the group how much I brought down my A1C level from 14.4 when a doctor first told me in February 1994 that I had type 2 diabetes. Now it is 5.1.


    But I fumbled at answering Dr. Reid’s question. Admitting that I am not an engineer with the engineering mentality that delights in numbers, I didn’t have an answer for why these numbers were so important to me.

    I do now.

    When we don’t have specific goals, we aren’t able to control our diabetes and our weight without them controlling us. The key is to be as specific as we can.

    To have a good chance at being successful in reaching our goals we have to go beyond acknowledging them to ourselves. We have to publicize them.

    That means we have to start by stating them in concrete terms. When our goals are weight loss, we need to express them in terms of the BMI we are aiming to reach.

    The BMI is a simple tool that relates our weight to our height. It applies equally to men and to women. It’s not perfect, since it doesn’t work for children, weightlifters and other heavily muscled types (because muscle weighs more than fat) and pregnant women. I especially like the U.S. government’s standard and easy-to-use calculator because it recognizes fractions of an inch in height and tenths of pounds in weight. You can easily find it online at http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm..

    If we would instead express our goals as pounds lost, we would give up something important. It would be easier to lose track of our goal. For example, I know one man who is famous for losing 180 pounds. That’s great, but he started from a weight of 410 pounds, and when I met him, his BMI was obviously above a normal level. 

    We need to set our weight-loss goal at a normal weight, which is a BMI of 18.5 to 24.9. In acknowledging it, we need to go beyond making a mental note of it. We need to write it down. Better yet would be to track it on a daily basis, which I do in a file on my computer.

    Just as important, we need to publicize it. We need to tell our families and friends both what our goal is and what our BMI currently is. We need to talk to them and write them too. We are essentially making a promise to our friends, and friends don’t break promises.

    Of course, we can change our goals. I originally set my BMI goal at 24.9, barely in the normal range, but it was based on the weight recorded on my discharge papers from the U.S. Army half a century earlier. After reaching that goal, I decided that I would be healthier and feel better if my BMI was 19.5. When I reached my revised goal, I made sure to tell people about it -- not to brag, but instead to keep the pressure on me not to exceed that weight.

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    Since we calculate our BMI by comparing our height and our weight, we need to be specific in determining these measurements. Our height is our height in the morning. 

    It’s not how tall we were when we were 20 or 30. All of us shrink at least a bit as we get older. We also shrink during the day, unless we are true couch potatoes and lie down all the time. How tall we are in the morning is a fair measure of our current height. It’s also a good time to weigh ourselves.

    I make sure to weigh myself every morning when I am home and can use my bathroom scale. I wrote about the reasons to weigh yourself daily in my article, “A New Way for People with Diabetes to Lose Weight.”

    The scale that we use needs, of course, to be accurate. It also should be a digital scale, not one of those old-fashioned analog types where we can too easily “interpret” our weight.

    Our weight has a lot to do with our A1C level. At a normal weight, we are able to maintain a normal A1C a lot easier.


    In my article, “The Normal A1C Level,” I reviewed the relevant research. My conclusion was that a normal level is much lower than the goals that the American Diabetes Association and other medical organizations would have us set. 

    No one knows for sure the level that active, healthy 20-year-olds typically have, but it is probably closer to 4.2 to 4.6 than to the maximum of 6.0 that one study shows that typical Americans have. That’s because Americans generally are overweight -- 66 percent of all Americans have a BMI of 25 or more. That must have at least some effect on their A1C level.

    I make sure to keep my A1C level as low as possible because I know that the chance of diabetes complications increases at any level above normal, and in fact, increases exponentially as our blood glucose rises.

     

    While I have reached my weight goal, my A1C goal is still a work in progress. I write about it both to put a little pressure on myself to do better and to motivate you to set an A1C goal in the proper range.

    Again, we need to be specific about the numbers. Not all A1C tests are created equal. 

    The standard recommendation is that “the test should be performed in a laboratory using a method that is National Glycohemoglobin Standardization Program (NGSP)-certified and standardized to the Diabetes Control and Complications Trial (DCCT) assay.” This means that the A1C test we use needs to be one of those on the “List of NGSP Certified Laboratories.”

     

    Not every A1C test performed in a doctor’s office or a hospital is on that list. But at least one home test is, the Bayer A1CNOW+. This is the test that I use to determine my A1C level.

     

    These are the numbers that drive my quest for great health, something available to those of us who have diabetes. My A1C and my BMI are the two numbers engraved on my mind.