Your Diabetic Report Card

Everyone who has elevated blood sugars should be familiar with what the normal ranges of blood sugar are as well as the ranges for the hemoglobin A1C.  These are the markers that will tell you and your doctor what kind of control is being achieved and what your risk of future problems will be.

Let's start with your blood sugar.  In a normal individual a fasting blood sugar (defined as first thing in the morning prior to eating) should be less than 100 mg/dl.  In a diabetic, the goal is to keep that level below 120 mg/dl.  Certain medications used to treat diabetes can lower blood sugar too much, such as insulin.  A level below 70 mg/dl is too low.  Levels in the 40's or 50's can be dangerous.  Low blood sugar reactions can cause spikes in blood pressure, induce heart attacks or even seizures.

Blood sugar levels after eating in diabetic patients should be less than 150 mg/dl.  The best time to check the level is two hours after a meal.  If it is checked too soon, the level will be uninterpretable.  Diabetics tend to have levels that both spike too high after eating and go down too slowly.  Some diabetics may have normal readings in the morning but higher levels after eating.  If the sugar is checked only in the morning, that may not be picked up.  Others may have readings that are higher in the morning but normal after eating.  This is due to an abnormal release of glycogen (long chains of glucose) from the liver at night.  Both conditions are bad but may be treated in different ways.

Over the last twenty years a test has been developed and validated that has greatly enhanced our ability to both detect and treat diabetes.  It is called the hemoglobin A1C.  Whereas instant blood sugar readings tell us the state in the blood vessel at any given instant, the hemoglobin A1C (hgb A1C) gives us an overall view of how the blood sugars have been over the previous three months.  The test has been validated both as a marker of control and detection of diabetes.  Every diabetic should know what their number is.  The test is a measurement of sugar molecules that form on the surface of hemoglobin (the protein that carries oxygen in red blood cells).  The life span of this protein is 3-4 months.  These short chains of glucose are measured in percentages.  A normal person will have a hgb A1C of 4.5 to 5.9%.  Early diabetes starts at 6.0%.  Levels above 7.0% are dangerous and require medications.  Repeated studies have shown that maintaining a level under 7.0% greatly diminishes the chances of diabetic complications.  That said, the time to action is not when it reaches 7.0% and beyond but the moment that it is found to be 6.0% or higher.  This is the time when diabetes can be reversed through diet and exercise.

Know your numbers.  If you are seeing your physician for an annual physical examination, your blood sugar will be tested.  It is my practice to then check an hgb A1C in anyone whose fasting glucose is above 100 mg/dl.  If you wait till you have symptoms of diabetes to be evaluated, it is too late.  Excessive thirst, hunger, weight loss, blurred vision and the like will only occur after the sugars have gone above 250 mg/dl.  The time for action is now, don't wait to get checked.