More Diabetes Answers

What is glycosylated hemoglobin (or hemoglobin A1c, HbA1c)?

As I said in The Diabetes Answer Book (page 83):

Hemoglobin is a protein inside all of your red blood cells.  It helps carry oxygen to your tissues to keep you healthy.  Every day your body makes a few million new red blood cells in your bone marrow.  These get pumped round and round your body for the next two or three months.  When the red blood cells get old, your body destroys them in your spleen.  Since the hemoglobin is floating around amongst the glucose in your blood, a small amount of glucose gets attached to the hemoglobin.  Hemoglobin with glucose attached to it is called glycosylated hemoglobin or hemoglobin A1c (HbA1c).  Brand new red cells have no glucose attached to them, but the longer they stay in your bloodstream, the more glucose gets attached.  The higher the glucose level in your blood, the more HbA1c you form.

We can measure what percentage of your hemoglobin has glucose attached to it.  This tells us what the average glucose level was in your blood for the previous ten to twelve weeks.  To give you an idea of how to use this information, a non-diabetic person's blood glucose will vary between about 20 and 160 mg/dl (3.9-8.9 mmol/L) throughout the day.  Over time about 4 to 6 percent of the person's hemoglobin will get glycosylated.  So the normal range for HbA1c is about 4 to 6 percent.  Now, imagine the worst possible blood glucose control.  If someone let his or her blood glucose average remain at 400 to 600 mg/dl (22-33 mmol/L) for months on end, the HbA1c could rise above 20 percent.  I have never seen HbA1c higher than 25 percent, but it can almost get to that level if someone leaves his or her diabetes completely untreated for long enough.

Doctors pay so much attention to HbA1c that it is important for you to understand what it is and how to interpret it.  I will refer back to this in other blog posts. 

Group Health Senior Caucus on March 20th

I am looking forward to speaking to anyone interested in diabetes at the Group Health Senior Caucus on Friday March 20th.  I am told that some of the written materials that were sent out have the wrong date on them and say March 2nd.  The correct date is March 20th.  I should be speaking between 10 a.m. and noon.  the location is at the Central Main Buidling (the old Group Health Hospital) at 201 16th Avenue East in Seatlle up on Capitol Hill.  We will be in the Doctors Lounge on the 6th floor.

I will be happy to answer any questions that you have about diabetes.

Why I wrote the book

    I was approached and invited to write this book for a publisher called Sourcebooks, Inc.  Their website is www.sourcebooks.com .  They are publishing a series of books called "The Fill-in-the-blank Answer Book" on a variety of medical topics.  There is The Asperger's Answer Book, The ADD and ADHD Answer Book, The Anxiety Answer Book, The Autism Answer Book, The Bipolar Disorder Answer Book, The Menopause Answer Book among others, and I think there will be many more coming.  For each clinical topic they have invited someone who is a nationally recognized clinical expert to give straightforward answers to three hundred or so of the questions that he or she is most commonly asked by patients and their families.  I was honored to be invited to write about diabetes.  I have been working as a diabetes specialist physician (sometimes called a diabetologist) for over thirty years and have seen many thousands of patients during that time.  I love to try to make diabetes more understandable to people and I have learned a lot from my patients.

I had no trouble coming up with about two hundred questions that I am often asked.  I put them into four categories and sent the list of questions to a few dozen of my favorite patients as well as some of the doctors and nurses that I work with.  I asked them if there were other topics that they would like to see answers on.  That added over a hundred more questions.  I have no doubt that there are still quite a few topics that I have not thought of, but I do hope that the ones in the book are helpful to you.

If you have read The Diabetes Answer Book and find that you don't fully understand the answer that I have given, or if you want to ask a follow-up question, or if you have a new question that did not appear in The Diabetes Answer Book, I invite you to write to me at this blog.  I will read your questions and will post answers to some of the commonest and best questions that you come up with and share them with anyone else who reads this blog.

You may be able to buy The Diabetes Answer Book at your local bookstore.  If not you can buy it online at www.amazon.com or at www.sourcebooks.com

How diabetes has changed!

     To say that the management of diabetes has changed in the past thirty years is a major understatement.  It has been transformed.  when I became interested in diabetes as a medical student in Edinburgh in the 1970s there were only two types of pill to help lower the blood glucose.  The insulin we used contained impurities that could cause ugly scars where it was injected.  Patients used large glass and metal syringes that had to me taken apart and boiled once a week to keep them clean.  The needles were large and had to be sharpened on a carborundum stone when they got blunt.  The only way to have any idea what your blood glucose level was involved urinating into a test tube, adding a Clinitest tablet, and seeing what color it turned when it had finished boiling and frothing.  While this exciting spectacle may have appealed to our inner alchemist the information that it gave was about as useless as hanging seaweed out of the window and inspecting the color of that  few minutes later.  People with diabetes lived in constant fear of passing out from low blood glucose levels (hypoglycemia) or of developing awful complication of their disease.  The day-to-day burden on their lives was enormous.

The past three decades have seen many advances.  There are now many different types of pill to help lower blood glucose and to protect the kidneys, heart, and blood vessels from the ravages of diabetes.  Now we use highly purified analogs of human insulin that can be delivered using disposable pens and tiny needles.  You can carry little meters in your pocket that can give you an accurate blood glucose reading in a matter of seconds from just a drop of blood.  Other tests allow us to know how well diabetes is being managed overall and how healthy the heart and kidneys are.  Insulin pumps,  inhaled insulin, continuous glucose monitors, pancreas and islet transplantation have all become realistic treatment options for some patients.

Yet people with diabetes till live in fear of passing our from hypoglycemia or of developing awful complications of their disease.  The day-to-day burden of their lives is still enormous.  The proliferation of new and alternative treatments and the blizzard of information and misinformation on the Internet and other media make life more confusing than ever for people who have to live with diabetes.

In The Diabetes Answer Book and in the things I write in this blog I will try to demystify diabetes and give you common sense answers to many of the questions that I get asked every day.  I hope this will give you encouragement, confidence, and strength to make good choices for yourself about how you live your life and how you manage your diabetes.  There are likely to be many more amazing advances in the treatment of diabetes in the next few years.  Make sure that you stay healthy enough to take advantage of them.

You may be able to buy The Diabetes Answer Book at your local bookstore.  If not you can buy it on-line at www.amazon.com or at www.sourcebooks.com