On this list of diseases and conditions I hate, COVID has now become #1. I have never seen any condition cause so much suffering. It is an awful disease, probably taking the worse toll I’ve seen on people in terms of destroying their health in the short term, and even in the medium term. The longer term, 20 years from now, I am terrified to even think about. But COVID for me takes that #1 spot because it’s also destroyed so many things not directly related to health—the economy, businesses small and large, how we shop, how we engage socially, it’s changed the political climate, and even our civility and respect towards other human beings.
The rest of my list is much more limited to the disease itself. They all just moved down a spot when COVID took over the top. Cancer is my #2, and Diabetes is my #3. The good things about Cancer and Diabetes, is every year, they get a little less awful. We are getting so much better at early detection, treatments, and management of both of those diseases. The best thing on those conditions is that cures are within reach.
Diabetes in some ways more than cancer has seen some big gains in the last decade. When I was a young nurse, diagnosis of diabetes was based on symptoms, serial fasting blood glucose levels, and glucose tolerance testing. Now it is a very simple blood test that literally can be done in most physicians’ offices in minutes. That test is a Hemoglobin A1c (HbA1c). HbA1c is a test that with a one-time blood sample as small as a drop of blood from a finger stick can tell you and your physician what your average blood sugar has run over the last 3 months.
The way that works is very simply, it takes about 30 days to make a blood cell and they live about another 60 days. As those cells are being made and floating around in the circulation, they absorb glucose (the type of sugar that your cells use for energy) based on how high or low the glucose in the blood is over that period. Think of HbA1c like a batting average for a baseball player. It doesn’t tell you what one game looks like; it tells you about the player’s performance over the season. One game doesn’t show who is great or terrible in baseball, but that batting average sure does.
Basically, HbA1c levels work like this. If your HbA1c is 4 your average blood glucose level is about 70—which is on the low side of normal. Between 4 and 5.6 is considered a normal HbA1c level, their blood glucoses average between about 70 and about 115. Someone with a HbA1C is 5.7-6.4 their average blood glucose is running around 120, which is the high end of normal. That range is known as pre-diabetes. A person is considered diabetic when their HbA1c is 6.5 or above. The ranges get interesting at that point. A HbA1C of 7 which is the top end of where a diabetic and their healthcare provider ideally should target management is an average glucose of 154, a HbA1C of 12, a level we see commonly in the hospital with poorly managed diabetics is a blood glucose of 298, triple a normal mid-range blood glucose level and nearly double a well-managed diabetic’s blood glucose level.
HbA1c is so reliable, that its ease of testing has made it much simpler for health care providers in finding the right medications for their patients, helping assess the risks of diabetes for that person, and developing a care plan that has lasting impact and limits the horrible complications that many diabetics face, like heart disease and strokes, renal failure, loss of circulation to arms and legs, poor wound healing (both of which can lead to amputations), blindness and many other very challenging health conditions. But mostly, HbA1c has helped us understand pre-diabetes.
We have learned that if we start managing pre-diabetes with diet, exercise, weight loss, and sometimes medications, we can keep people from ever becoming diabetic. An estimated 80 million people in the US over 20 have pre-diabetes and don’t know it. Diabetes is like everything else in health care: prevention is the best medicine, and if you can’t prevent, intervene early. During the month of November many organizations offer free or greatly discounted HbA1C testing. If you haven’t had an HbA1c done recently, consider getting that testing and then discussing the results with your primary health care provider. Don’t be one of those people who are pre-diabetic and don’t know it until they are diagnosed with diabetes and facing major complications.