Dr. Sharon Orrange
Primary Care Physician
Dr Orrange received her BA in Biology at the University of California San Diego and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health She received her MD from the USC Keck School of…
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LOCATION: Santa Monica, CA, USA
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AFFILIATIONS:
  • Assistant Professor of Clinical Medicine, Division of Geriatric, Hospital and General Internal Medicine, Keck School of Medicine, University of Southern California
YEARS IN PRACTICE: 11
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What's the Best Test for Diabetes?
10
Posted in Acne by Dr. Sharon Orrange on Jun 21, 2009
"I've had tingling in my feet", "I've been urinating a lot", and "I've been really tired and haven't felt right?" Could this be adult-onset Diabetes? Many people come to the office with signs and symptoms they are worried may represent diabetes and ask me about a "test for Diabetes". Until now the standard of care has been that a FASTING blood sugar > 126 on two separate occasions or a random blood sugar > 200 could seal the diagnosis. This is hard for some of you who come to the office without having fasted (had nothing after midnight) and for those of you who have been "bad" on your vacation or cruise you just took.

Finally, an International committee of experts agrees that the Hemoglobin A1c (Hgb A1c) be the recommended method for diagnosing Diabetes. This is one easy blood test which can be done in the office with a finger-stick and you don't have to be fasting for it.

What is the Hemoglobin A1c? Hgb A1c stands for glycosylated hemoglobin, which is Hemoglobin to which glucose is bound. The level of glycosylated hemoglobin (Hgb A1c) is increased in the red blood cells of persons with poorly controlled diabetes mellitus. Since the glucose stays attached to hemoglobin for the life of the red blood cell (normally about 120 days), the Hgb A1c reflects the average blood glucose level over the past 3 months.

What are the advantages of using the A1c to diagnose Diabetes?  It's more convenient than fasting glucose testing or two-hour glucose-tolerance testing. With current technology, A1c tests are as accurate and precise as the other measures, and provide a better index of overall exposure to high blood sugars (taking in to account periods of time you've been "bad" and "good"), and risk for long-term complications.

This report published by an international panel of experts recommended that patients with an A1c of 6.5% or higher be diagnosed with diabetes. Patients with A1c between 6.0% and 6.5% should be considered at highest risk of developing diabetes.

Do you start treatment for Diabetes for an Hgb A1c of 6.5%? There has always been controversy as to whether or not to start metformin (glucophage) or another oral medication for an A1c of 6.5% given that our treatment target for Diabetes is 7% or less. My feeling is, it is reasonable to go with diet and lifestyle changes once you are diagnosed with diabetes based on an Hgb A1c of 6.5% as long as you stay below 7%.

With the adoption of the A1c of 6.5% or higher as diagnostic criteria for diabetes let's hope more people are screened early so lifestyle changes (diet and exercise) can be initiated and medications avoided until as long as possible.

Dr O.

 

 


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Displaying comments 10-1 of 10
10
Can a A1c test give a reading for low blood suger as well?
By CatKrzy  Oct 27, 2009
9
Diabetes is a serious condition and unfortunately many people dont even know they have it. This is why regular checkups are so important.

http://www.acaiberrytime.com
By barrypeters  Sep 16, 2009
8
Could anyone help explain what a diagnoses of Pre-diabetic due to slightly elevated blood sugar levels really means.....Thanks! All they've told me to do is check my sugar levels with finger tester and watch diet so far.....I dont know what it really means to have this though, and am disabled with Lyme on top of it, so cannot understand things/register them correctly anymore....
By SoulSeekerofTruth  Aug 13, 2009
7
This information open my mind with this terrible kind of cancer in blood. Well all I know about this matter is that proper diet and regular exercise is needed for the person who has this illness. Great that you have this important materials to inform us clearly about this matter. However, if you need a short term loan urgently, and a company that can get you instant approval and use direct deposit to help you avoid overdraft and save your credit and guarantee your privacy, then a payday loan company has the quick cash you need.
By JakobO  Jul 17, 2009
6
Thank you for the information. I will be asking for this test at my next visit. I believe that there is too much emphasis on diabetes from the pharmaceutical community. Just months ago, all the "free" literature in my doctor's waiting room was related to heart disease and cholesterol. Now it is all about diabetes.

Millions of new customers await with chemical diabetes treatment and all represent an annuity to the drug companies if they can only get diagnosed. Diabetes is a heartbreaking disease, but it is also a guaranteed revenue stream for Big Pharma
By Flemmit  Jun 24, 2009
5
I call A1C the 'Long Term blood sugar' and my doctor normally wants to give me only 1 test per day, but since my sister gave me supplies with a better machine, I used that for several months and it helped more since I learned its better to eat and 2 hours later check my blood sugar, and I have enough supplies for up to 2 months and then I will get the better ones, I found out from a diabetic friend about Calibrating the machine every two weeks, no one has mentioned this to me otherwise. My A1C was 6.2-6.5 and now its 5.6 and now I am walking three times a day although mostly in the late afternoon since its very high heat index. What can I do to encourage my doc to give me more supplies? My friend takes insulin and he takes it up to 7 times a day and yet the supply company only gives him enough for 3 test a day and he will need more when he has a stomach insulin machine and his doctor is failing him and mine is failing me. I found out that I can ask most important tests and the doc will do so if he sees the need and he has taken a lot and I was shocked since I am on medicaid. I am sorry for this being so long. I have a wonderful foot doctor, but shes a NP, but she is very qualified and treats me better than my regular doctor.

What about doing an article on SellYouLiteUs, I had to have a lot of Anti-boilitcs and it helped a lot, I had knee pain and the doc gave me test on knee and I was grateful he did it and I found out I have arthritis, but I at least know. Before I left, I shared with nurse dept how grateful for how well I was treated and the people who looked to see if I had another blood clot in legs and found the other problems. The food became much better in the last four days when they had more fiber and less sodium which meant a lot. I have the impression many don't say this and this is mostly for low income, but I was very grateful.
By Vernonbro  Jun 24, 2009
4
I am glad you mentioned 'adult-onset' although I prefer the term 'type 2' since I know of many adults who were diagnosed with so called 'juvenile onset' (or type 1) diabetes in adulthood, one in particular who was around 50 at diagnosis. But it is good you specified which type of diabetes you were talking about, so many especially in the media just say 'diabetes' and do not specify, when the types are very different.
By Lizzie  Jun 24, 2009
3
Dr O,
I just started reading these blogs a few weeks ago and love 'em. Keep it up and thanks for taking the time.
By EasyM  Jun 23, 2009
2
True, and as a diabetic myself, I can only say incorporating healthy overall lifestyle at any time is best. If we don't learn to manage our coping lifestyle etc., we risk our health.

Though, technology brings hope to the growing mass of specific diagnoses, in most, lies other issues. Treatment & healing needs more than medication.

As ideally, we would all hope that as a society - priorities would be more open to incorporate/educate/treat better means to develope healthier well-beings -- in less confusing manners.
By it2speaks  Jun 22, 2009
1
This is an amazing discussion! In the celiac support group, we are currently contending with a user who hijacks EVERY thread to demand that we agree with an opinion of one test being absolutely necessary to actually have celiac disease.

Your article comes just when frustrations with this user are very high. If diabetes, which has been studied for much longer than celiac, still has questionable diagnostic problems, how can one person campaign so vehemently for a testing that has known problems?

Thanks for the article at just the right time
C
By catlovesdi  Jun 22, 2009
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