Sugar Matters
February 22, 2011
Direction counting

Before I start our discussion this week, I would like to send out a happy reminder: our Patsy Douglas Youth Empowerment Foundation Diabetes Mission trip is almost on its way! Don’t forget Vincy family: we will be working throughout our island nation from March 20-25th. We are especially excited about the health fair planned for Friday 25th, in concert with the Diabetes and Hypertension group at home and local health professionals.{{more}} Keep us on your radar!!!

Now on to this week’s business: monitoring over time.

I recently was asked to see a gentleman in consultation for assistance with diabetes management. As it turns out this gentleman had stomach surgery a few years back, in order to help treat his being extremely obese (what we call “morbidly obese”). As a result of his surgery, he lost 90 pounds, and his diabetes, which he previously had for 10 years, was gone. Or so it seemed. His A1C at our hospital was 6.7%, which actually is still at goal of less than 7% but counts as being in diabetic range.

This gentleman is already doing much of what he needs to do with diet and exercise. He had a major surgery to help his problem of morbid obesity. The question on my plate was whether or not to start him on any medication at this point. Some of you may be saying, really, start a medication for an A1C in that good range? You must understand that this gentleman was in the hospital with heart disease. He remains at very high risk for future heart problems, so keeping his blood sugars well controlled is CRITICAL in keeping him healthy over the next many years of his life. An A1C of 6.7 is good, but it is still in diabetes range. Then he told me something that turned the story around.

He said that his A1C had been checked a few months ago and it was 7.4% then.

After hearing that piece of information, I discussed with him that indeed his diet and exercise regimen was working. Therefore I would suggest holding OFF on any medication for now and continuing to monitor carefully. If his A1C were to rise in future, or he noticed finger stick blood sugars to be rising, then he should consider restarting Metformin as his medication.

The point of this story is two-fold: first, notice that YES diet and exercise DO HELP and impact blood sugar control if you are dedicated to it. Second, it was important to know what his PRIOR value of A1C was, in order for me to appropriately judge his current level. The immediate level is important, but SO IS THE DIRECTION of how his sugar control has been over the past few months and year. If he had said to me that his prior A1C was 5.5% instead, then I would have suggested he start on medication NOW because his glucose levels were rising and not getting better.

The moral of this story is that you MUST get labwork done when your doc asks. If you have a glucose meter, please check you sugars and bring the record of them to your clinic visit. Knowing your pattern of blood sugars over time is an important aspect of your care, and can totally change what your doctor suggests to you.

Until next week, stay safe and healthy Vincies!

Anita Ramsetty, MD

Medical Director Endocrine Care Group

Tel: 843-798-4227