A1C numbers

[Jeffythequick]

What scares me most about uncontrolled diabetes is that it doesn't kill you right away. Chances are you will end up with many years of severe pain/ discomfort, followed by limb loss, or stroke or heart disease. I have a friend who has been nonchalant about his type II for 20 years. Now he has neuropathy which affects his feet. He can tolerate it during the day, but at night he says it is unbearable to the point he has been begging for pain killers. He still hasn't really made the correlation between controlling his blood sugar and these consequences.

The thing that I don't get is the A1c of 6.5% is OK, when "normal" people have one of 4.5-5.5%. I do think it is a "low blood sugar will kill you in an hour or two, and high blood sugar will kill you in 20-30 years" thing.

Does my blood sugar go above 200? Yes. However, with the CGM, I take immediate action to get it back down. Do I go low? Yes. I carry glucose pills to mitigate it.

 

[Cooter]

The thing that I don't get is the A1c of 6.5% is OK, when "normal" people have one of 4.5-5.5%. I do think it is a "low blood sugar will kill you in an hour or two, and high blood sugar will kill you in 20-30 years" thing.

Does my blood sugar go above 200? Yes. However, with the CGM, I take immediate action to get it back down. Do I go low? Yes. I carry glucose pills to mitigate it.

I kind of think of it like a graph where potential damage is plotted exponentially. Very little change occurs initially as you move out of the normal zone. But as A1C continues to increase, the harmful side effects are increasingly likely. When factored against the threat of going too low, 6.5 to 7 is a safe trade off.

 

[neilw2]

The thing that I don't get is the A1c of 6.5% is OK, when "normal" people have one of 4.5-5.5%. I do think it is a "low blood sugar will kill you in an hour or two, and high blood sugar will kill you in 20-30 years" thing.

The reasoning is this is pretty much the lowest you recommend treating to for the average patient to lower this risk of long term health defects while not putting a patient at too high a risk of hypoglycemia. It is certainly a balance and this is where studies have found that most diabetic people- when they are at 6.5-7 have a low likelihood of developing comorbidities due to their diabetes. You being able to have a a1c of 5 is making that long term risk even more remote.

 

[neilw2]

jinx @Cooter

 

[flyingron]

what about post #15?

Except again, that doesn't say that just getting to 6.5 makes things OK. If you are not a type I diabetic, you want to be lower. Getting down to 6.5 for a diabetic is exemplary control and gives them the best possible outcome, but it doesn't mean that they aren't going to have complications. On the other hand, getting below 6.5 with type I may result in other health issues, hypoglycemia can cause serious neurological issues, etc...

There's more to endocrinology than one slide that is condensing the results of a 40 page journal article.

To get back to the original question. Normal has and is considered 5.7 or below. Above that, and below 6.5, you're considered at a diabetic risk. About 6.5 you're considered diabetic.
Now as with all tests, there are issues with both accuracy and applicability for a particular person. In fact A1C is pretty much only accurate +/- .5% anyhow. If you're 5.7, you really n eed to be checked out further.

 

[neilw2]

Except again, that doesn't say that just getting to 6.5 makes things OK. If you are not a type I diabetic, you want to be lower. Getting down to 6.5 for a diabetic is exemplary control and gives them the best possible outcome, but it doesn't mean that they aren't going to have complications. On the other hand, getting below 6.5 with type I may result in other health issues, hypoglycemia can cause serious neurological issues, etc...

There's more to endocrinology than one slide that is condensing the results of a 40 page journal article.

To get back to the original question. Normal has and is considered 5.7 or below. Above that, and below 6.5, you're considered at a diabetic risk. About 6.5 you're considered diabetic.
Now as with all tests, there are issues with both accuracy and applicability for a particular person. In fact A1C is pretty much only accurate +/- .5% anyhow. If you're 5.7, you really n eed to be checked out further.

Ron most of what you say is very true and I agree with almost all of it. But I would argue it doesn't matter if you are a type 1 or 2 diabetic, there is still increased risk of hypoglycemia when making your goal <6.5 for most patients. If you do what @Jeffythequick does and monitors closely yes it is perfectly safe to do that (and VERY healthy to keep it lower). But again, that is not the average patient- actually based on my experience there is prob less than 1% that takes such an active stance on controlling BS.

I could nerd out with studies and the like all day covering all possible situations but your overall premise of doing everything you can within reason to lower your blood sugars is the most important point!

 

[Cooter]

The Doctor should specify a target A1C. It will be based on your blood sugar history and how well it has been controlled. Too many lows indicate that you may need the A1c target to be raised. I don't remember the specifics offhand but I know for children the target A1C is up around 8. And as they get older with good care there A1C target is lowered. The CGM and pump have really improved our ability to manage it to much better tolerances and avoid prolonged periods at the extremes.

 

[Checkout_my_Six]

Tom....lemme hep ya out wit dat....

 

[Tom-D]

Tom....lemme hep ya out wit dat....

Well there ya go, all I was getting was drug advertising.

 

[guest]

Doc put me metformin about 6-7 months ago & went in for flight phys couple days ago. She didn't mention it to me but while I was waiting on the piece of paper the front office said the Doc would send it to the FAA and I would hear from them. So, what can I expect to happen, and how long until I get the approval. Blood work good except A1C 6.9 last time tested for it then put on the metformin 6-7 months ago. They did take blood the other day but don't know the results yet.

 

[bbchien]

I've missed this string. Actually Tom-D is incorrect, 9.0 is the highest absolute HbA1c limit for any kind of certification...but who's kidding whom(?) at that level.
6.5 is associated with decent long term survival, and it the highest, if on metformin alone , that the AME can issue without an SI.

 

[Tom-D]

I've missed this string. Actually Tom-D is incorrect, 9.0 is the highest absolute HbA1c limit for any kind of certification...but who's kidding whom(?) at that level.
6.5 is associated with decent long term survival, and it the highest, if on metformin alone , that the AME can issue without an SI.

Bruce, I made 6.1 this year on 200 mg twice per day, new diet, and exercise program. Dr. issued class 3 for 2 years. Thanks for the ce
clarification, on the metformin numbers.

 

[midwestpa24]

So dumb question, does the usual medical include an A1C test?

 

[Checkout_my_Six]

So dumb question, does the usual medical include an A1C test?

No...mine does a Pee test....with a test strip. It has to be real bad (sugar in the urine) for that to alert. My last blood test a month or so ago had my A1C at 6.0...so the pee was fine.

 

[Tom-D]

So dumb question, does the usual medical include an A1C test?

No, high sugar in the urine pops on pee test strip.

But when your AME is also your family Dr. they know you are diabetic

 

[bbchien]

jeffy, never did get a e-mail..,,

 

[Boyfalldown]

Google it and all you get are a bunch of medical advertisements.

How high can the numbers be before they are a hazard to your health?

6.5 on metformin is as high as the FAA will allow to fly

Well thats a god question I've been asking myself a lot too. Six months ago I was diagnosed with type 2 and an a1c of 12.7.

I'm only 38, and being a crusty old airport guy in my 80's or older is a big goal of mine. Preferably i'd like to reach that age with all my limbs, decent eyesight, and no neuropathy. Uncontrolled diabetes makes the likelihood of that pretty low. I'm well less than halfway through my desired lifespan and have already reached tbo on my pancreas... so from here on out I've chosen to take a pretty conservative route with my health.

The guidelines from American Diabetes Association seem like complete rubbish to me. An a1c of 7 and post meal spikes of 180 mg/dl just are not acceptable to me. Most of the information I can find states organ and tissue damage occurs at blood sugar levels above 140 mg/dl which coincides with an a1c of 6.5. I set my blood sugar goals to never spike above 130, and I check 45-90 minutes after each medal or snack.

I have embraced a low carb lifestyle and its working really well for me. The first book I read on the subject was Richard Bernstein's "Diabetes Solution" and it was a lifesaver, literally. I'm currently treated with only metformin and diet. After 3 months of diet and metformin my a1c was down to 6.3 and at 6 months I'm down to 5.6. I feel a LOT better than I did 6 months ago. I don't really like being a diabetic so I aim to have non diabetic blood sugars. Hopefully my downward trend on a1c's continues and I can maintain them long term. Dr. Bernstein's target blood sugar is 83 all the time (hard for a type 2) which is an a1c of 4.5. While 4.5 is my goal, I'm happy anywhere in the low 5's.

I own an old skylane and fly 150 or so hours a year simply for enjoyment. Flying is a huge part of my life and one of my greatest sources of enjoyment. As soon as I was diagnosed I self grounded and didn't fly without another pilot, that really sucked. In an odd way I'm really happy that the 3rd class requires an a1c below 6.5 (for a non special issuance). It immediately gave me a goal to reach, and in learning how to get there I realized that even 6.5 is less control than I should accept.

My only dilemma will be if I ever need to move to insulin. Currently one must show 6 months of use without a hypo. I really am not looking forward to taking 6 months off flying solo.

 

[Tom-D]

12.7 WoW ! and I'm worried about 6.5. ??

Keep up the good work.

 

[Volzalum]

My A1c numbers have varied from low 5's (eating very low carb) to high 7's (eating anything I've wanted and chasing the bubble with insulin) for the 16 years I've had Type 1 diabetes. I've recently (~6 months) started using a Dexcom G5 Continuous Glucose Monitor (CGM) connected to my iPhone and Apple Watch. It has helped me get my blood sugars to be much more stable.

 

[Cooter]

My A1c numbers have varied from low 5's (eating very low carb) to high 7's (eating anything I've wanted and chasing the bubble with insulin) for the 16 years I've had Type 1 diabetes. I've recently (~6 months) started using a Dexcom G5 Continuous Glucose Monitor (CGM) connected to my iPhone and Apple Watch. It has helped me get my blood sugars to be much more stable.

How is it helping to stabilize your BS? Do you make more corrections after meals or is it because you see the trends and are able to make better dosage adjustments before eating?

 

[Volzalum]

For me, I made my alerts start at 70 on low end and 150 on high end. When I first got it I kept my normal patterns for 2-3 weeks. What I found was that even though when I'd been checking it 4-6 times per day and usually near the range, that I was actually having some large peaks after meals before it would turn back down. With the GCM info, my endo and I were able to change my long lasting dose and split it to twice a day. The adjustments have me where my peaks and valleys now stay in the range way more regularly. The immediate knowledge also lets me watch trends and make adjustments before it gets out of the band. To me the usefulness of the watch is excellent to just lift my wrist and see what my BS is. And since it is now legal to dose on the G5, I only have to prick finger twice daily for calibrations.

 

[Cooter]

That's great, the G5 made a big difference for us as well. It's good that your staying on top of it, which will surely pay off in the long run.

 

[bflynn]

Google it and all you get are a bunch of medical advertisements.

How high can the numbers be before they are a hazard to your health?

6.5 on metformin is as high as the FAA will allow to fly

Actually, 6.5 is the highest the AME can issue via CACI. You can fly up to 8.9, but it requires an SI after 6.5.

As far as "being a hazard", it's a hill, not a cliff. Lower is better.

 

[Tom-D]

Actually, 6.5 is the highest the AME can issue via CACI. You can fly up to 8.9, but it requires an SI after 6.5.

As far as "being a hazard", it's a hill, not a cliff. Lower is better.

That's kinda what my Dr told me, 6.5 I can't do it.

 

[Jeffythequick]

For me, I made my alerts start at 70 on low end and 150 on high end. When I first got it I kept my normal patterns for 2-3 weeks. What I found was that even though when I'd been checking it 4-6 times per day and usually near the range, that I was actually having some large peaks after meals before it would turn back down. With the GCM info, my endo and I were able to change my long lasting dose and split it to twice a day. The adjustments have me where my peaks and valleys now stay in the range way more regularly. The immediate knowledge also lets me watch trends and make adjustments before it gets out of the band. To me the usefulness of the watch is excellent to just lift my wrist and see what my BS is. And since it is now legal to dose on the G5, I only have to prick finger twice daily for calibrations.

Yeah, I have mine set to 70-180, and with exercising season starting up, I may bring it down to 150 on the top end.

I thought I was doing badly over the holidays, but my A1c was 6.3.

I love that "legal to dose" part... Judas Priest's "Breaking the law" comes to mind for me over the last few years... I'm looking forward to the CGM/Pump combos coming up in the next couple of years. My Tandem X2 is looking forward to an upgrade to get the Dexcom software into it, and then, next year, getting the Type 0 upgrade for active dosing.

 

[ralarcon]

And just to prove i'm not full of it here is the ACP guidelines on diabetic treatment goals:



source: http://annals.org/article.aspx?articleid=1033354

And the ADA guidelines:

This is the real answer to the OP question. This is the general consensus of the American Diabetes Association. Cannot get more specific than that because studies do not allow it. This is based on specific scientific statistical evidence. Mileage varies, individually, and **** happens, no matter what your numbers are.

Cheers

 

[iRyan]

Does A1c predict diabetes?

 

[neilw2]

Does A1c predict diabetes?

No, more like A1c confirms a diagnosis. Your A1c is really a measure of your average blood sugar over the past 3 months. If it is high (say greater than 5-5.5 for non-diagnosed patient) than you will probably be diagnosed as diabetic, or at least pre-diabetic.

 

[ralarcon]

Does A1c predict diabetes?

I'm not sure what you mean by "predict", but in most medical laboratories an A1C of 6.5 or higher is consistent with Diabetes.

Cheers

 

[iRyan]

No, more like A1c confirms a diagnosis. Your A1c is really a measure of your average blood sugar over the past 3 months. If it is high (say greater than 5-5.5 for non-diagnosed patient) than you will probably be diagnosed as diabetic, or at least pre-diabetic.

Interesting. Thanks you. I only had mine tested one time and it was this past summer. It was 5.0 but I didn't know if that was a good number.

 

[ralarcon]

Interesting. Thanks you. I only had mine tested one time and it was this past summer. It was 5.0 but I didn't know if that was a good number.

When the A1C test is used to diagnose diabetes, an A1C level of 6.5 percent or higher on two separate occasions indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes.Jan 7, 2016

Cheers

 

[Jeffythequick]

When the A1C test is used to diagnose diabetes, an A1C level of 6.5 percent or higher on two separate occasions indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes.Jan 7, 2016

Cheers

Is that Type 2 Diabetes?

I can only imagine, for a T1D, that is a bit after the fact (of a hospital visit and a diagnosis...)

 

[midcap]

I am trying to remember my highest A1C, maybe a 7 when I was diagnosed with T2, went on metformin. It made me feel sick all the time. Went on a ketogenic diet and lost some weight, a1c's were at 5.1 without any medication.

 

[ralarcon]

Is that Type 2 Diabetes?

I can only imagine, for a T1D, that is a bit after the fact (of a hospital visit and a diagnosis...)

Type 1 Diabetes is Juvenile onset Diabetes. Whereas Type 2 Diabetes is Adult onset Diabetes.

Cheers

 

[ralarcon]

I am trying to remember my highest A1C, maybe a 7 when I was diagnosed with T2, went on metformin. It made me feel sick all the time. Went on a ketogenic diet and lost some weight, a1c's were at 5.1 without any medication.

This would be diet controlled Diabetes.

Cheers

 

[Volzalum]

Type 1 Diabetes is Juvenile onset Diabetes. Whereas Type 2 Diabetes is Adult onset Diabetes. Cheers

But don't let the 'Juvenile' vs 'Adult Onset' be your focus. I was 29 years old when I was diagnosed with 'Juvenile' diabetes.

 

[ralarcon]

But don't let the 'Juvenile' vs 'Adult Onset' be your focus. I was 29 years old when I was diagnosed with 'Juvenile' diabetes.

Did not want to get too complicated , but here you go;

"Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow sugar (glucose) to enter cells to produce energy. ... Despite active research, type 1 diabetes has no cure. But it can be managed." Mayo Clinic.

Cheers

 

[bflynn]

Does A1c predict diabetes?

I read the other posts answering this, but want to add to it -

I'd say it's more accurate to say that A1C measures the degree of diabetes. Diabetes is a disease defined by excessive blood glucose. There is always some glucose in the blood and that glucose binds to Red Blood Cells (RBCs). But, RBCs only last for 3 months. The A1C test then measures the degree to which blood glucose hasb bound to RBCs over the past 3 months. A reading is an average percentage of blood glucose for 3 months, giving a better picture of what a patient's exposure to glucose has been. The A1C reading can also be converted to an average blood glucose level. Given a reading of 6.5, the average glucose was 140 mg/dl.

6.5 is just the threshold. Someone with a long time reading of 6.4 will suffer about the same effects as someone who is at 6.5

 

[eaglepilot]

For me, I made my alerts start at 70 on low end and 150 on high end. When I first got it I kept my normal patterns for 2-3 weeks. What I found was that even though when I'd been checking it 4-6 times per day and usually near the range, that I was actually having some large peaks after meals before it would turn back down. With the GCM info, my endo and I were able to change my long lasting dose and split it to twice a day. The adjustments have me where my peaks and valleys now stay in the range way more regularly. The immediate knowledge also lets me watch trends and make adjustments before it gets out of the band. To me the usefulness of the watch is excellent to just lift my wrist and see what my BS is. And since it is now legal to dose on the G5, I only have to prick finger twice daily for calibrations.

I checked on the G5 online.

Questions

Is the sensor sturdy? Does it get in your way during exercise?

I play hockey a couple of times a week, and usually get bumped around 2-3 times a game (into the boards, knocked down)... Do you think it would stand up in this case?

Thanks

 

[Jeffythequick]

I checked on the G5 online.

Questions

Is the sensor sturdy? Does it get in your way during exercise?

I play hockey a couple of times a week, and usually get bumped around 2-3 times a game (into the boards, knocked down)... Do you think it would stand up in this case?

Thanks

I think the G5 sensor would stand up to that kind of abuse, however, it may not stay attached. There are times when mine will be fine wrestling with an 8 year old, 9 year old, and an 11 year old, but then come off when I slide in my bed (just turning over, it gets caught in the sheets). I've never had one get damaged beyond repair. It's the sensor/transmitter coming out/becoming detached which is the issue for me. Wrapping some tape over it (I mean, all the way around your body/arm/leg/wherever it is inserted) may help with it being pulled out. It's the shearing of the sensor on your body that tends to pull them out.

I ride my bike for exercise, so there's very little contact then, but I've only worn the sensor on my abdomen. I think that I'll try it on my arms for a while. I've seen other diabetics wear them on their upper arm, so that may be an option for you.

The G6 transmitter, I hear, will be smaller, so that's something to look forward to as well.