A1C Level

[GoldenKatie]

Since my doctor has not been following my diabetes, today I used a Health Screening site to check my A1C and paid for it out of my own pocket instead of using my insurance.  It's been almost a year since the doctor felt it necessary to check it.  It is 8.0.  The only diabetes related problem I'm aware of having is a fairly high amount of protein lost in the urine.  I've been diagnosed with diabetes for about five years and have worked hard to keep it under control with diet and exercise.  I'm on 2.5 Glipizide and have been for years.
     My mother passed away from complications of diabetes and my sister is on insulin.
     I was in the doctor's office a couple of weeks ago and again he did not address the diabetes and ordered no labs.  He said, I'm sure it's fine.  He was removed from the office practice last week.  This means I will be assigned a new doctor.  (yeah!).
     My question is since I've had no diabetes education -- how significant is a reading of A1C of 8?  I'm thinking it's not that bad, but may mean some additional oral medication????  I feel like I've been out there by myself floundering around.  Any insight would be helpful.

Thanks,

[ChickaBoom]

"a fairly high amount of protein lost in the urine"

Do you know if you are still having protein loss in your urine? You said your doctor didn't do lab work so I am guessing this was something from your past.

You only mention being on Glipizide and not on anything to protect your kidneys. Sometimes people can spill protein and it is normal for them. Sometimes you can have measurable protein in your urine for other reasons so it might not be a current problem. But as a diabetic, you really want to follow-up on this. At minimum, annually, you need a urinalysis to check for microalbumin and protein.

The AC1 of 8 just says you probably don't have good control of your diabetes and need to either adjust your medications, increase your exercise, decrease your stress (and I don't think that will happen soon - so sorry your husband need surgery), or improve your nutrition. Your statement about protein in your urine is worrisome because it says you may be getting into one of the complications of diabetes - kidney disease. Take time to make an appointment with your PA - write or call her and explain you want your annual lab work done first before you come in for the visit. This way, she will have the values in front of her when you go for your follow-up.  

Annual lab work is generally a fasting blood sugar, CBC, BUN/Creat, Urinalysis with microablumin check, A1C, lipids, cholesterol panel and other dependent on medication and other medical conditions though this can vary.  Since you already have the A1C, you can use that one for this visit. Take a copy with you. But, you do need at minimum the Urinalysis, lipids, cholesterol panel, BUN/Creat. http://www.aafp.org/fpm/20000900/51maki.html#box_b

[troytroy]

You should also be aware of the impact of stress on blood sugar levels. A couple of years ago I retired from a very high stress job in Washington DC. While I was workingv my A1c stayed around 8 and ocasionally spiked up to 9, Both my diabetes & heart doctors advised me to leave my job and find something less stressful to do. I returned to Texas and got more rest and my A1c level dropped below 7.

Since you are the major care giver for your husband you probably have very little time to rest, meditate or just free your mind. I practice biofeedback,which works for me and I can reduce my blood pressure from 15- 20 points by just sitting and meditating for 20 minutes.

Please take care of yourself and I will pray for your husband and you.

Troytroy

[GoldenKatie]

Thanks for the comments on the physician assistant.  I've seen her a couple of times in the past and I really did like her.  I think this is going to work out good.  The doctor she works under is the doctor my husband sees so I have a relationship with him too since I go to all appointments with my husband and is his advocate.  He is a great doctor but is not accepting new patients.

I work hard with the diet and exercise but I must admit I have fallen off the wagon lately with a lot of life issues crowding in.  That's why I was concerned about the A1C.

Thanks for your encouragement and support and yes, you're right - Long's is going to CVS.  

[WaveRider]

I'm familiar with Longs (now CVS) as I live in the No Cal Bay Area but I did not know about their labs. I'll have to check into that, thanks.

An A1c of 7% says you're diabetic and need to begin glucose control before diabetes side effects take control of your life. Diabetes control is easy and has three main components:
1. Proper nutrition - stay away from sugary foods and bad carbs. The later turns into sugar. Google "diabetes nutrition" for suggestions. Use Splenda granulated instead of sugar. Problem with Splenda is it doesn't mix well with flour so you can't bake with it. Don't use the Baking Splenda for it contains sugar.
2. Moderate exercise like walking. Park at the end of a lot and walk the short distance to the store.
3. Maintain normal weight.

The American Diabetes Association web site has tons of useful information including recipes. Check it out when you get a chance.

And, best wishes to your husband too.

[Zoelula]

I lived and worked in a small mountain community, Katie, so I know how hard it can be getting services. Fortunately, we were just an hour away from a larger town that had more options, but it sounds as though you are not?

I personally have had very good experiences with Physician's Assistant and feel that sometimes they are more caring than MDs (less god complex?)

I'm wondering if you test at home regularly? Especially with your medical situation, that would be a way of keeping track in much closer time than the A1C so that you can catch the changes in numbers.

Good luck to you. I understand that your husband's situation needs your attention, but don't forget to take care of you too!
Zoe

[GoldenKatie]

I just noticed that I didn't include their range of <7 which is = diabetes in control.

[GoldenKatie]

Thanks Wave,

Our Long's Drug (a large West Coast chain drug store) has a health screening day a few times a year where they do several tests for a price.
     The range they provide is:  6 and below = non diabetic; 8 = action suggested.
     In my case, it's a little easier said than done to fire one doctor and go to another.  I live in a small mountain community.  In fact, I'll be turning my care over to a physician assistant because I don't know of any doctors in the area who are taking new patients.
     My husband will be having brain surgery next week so I'm not sure when I'm going to be free to go back to the doctor (physician assistant).  My husband requires my 24/7 care.  
     Thanks again Wave

[WaveRider]

"I used a Health Screening site to check my A1C "
Please clarify. This "site" was it a medical clinic? What were their A1c lab result' ranges? The range should be noted on your lab sheet. I ask because labs tend to differ in ranges. In most case an A1c <6% (less than) is considered normal but you lab may see it otherwise. Without knowing the range its impossible to answer your question.

It's good that you are getting another doctor. Be sure this new one listens to you. If you feel a doctor is not listening nor providing the care you desire, fire him/her and find one that does. Keep looking until you do. Its your right as a patient to have proper medical care and to have your questions answered thoroughly.