Explaining Normal Blood Sugar Isn't Always Easy
I have the dubious honor of being the medical go to person for friends and family when it comes to medical questions. Over the years I have taken the responsibility more seriously and regarded it as less of a burden.
Being in healthcare administration for several years, I have seen many patients and families totally lost and devastated trying to navigate the system and so I try to make it easier for those close to me. Sometimes even explaining processes, roles, and test results go a long way in allaying concerns. I realize that many healthcare practitioners are not always totally conversant with medical lab science and unwittingly give incomplete or even incorrect information to patients.
Patients, on the other hand, are sometimes reluctant to ask questions of their practitioners; or are too confused to realize what they dont't know or what they need to ask.
I was talking to my friend, Tom, a few days ago and he reminded me how I had explained to him years ago the various tests for diagnosing diabetes. He was diagnosed back in the day when a fasting glucose level was considered normal up to somewhere around 115mg/dl. His doctors had different cut offs and he got really confused when one physician wanted to diagnose him as diabetic based on a random blood sugar and another wanted to subject him to an oral glucose tolerance test before making a firm diagnosis.
Over the years since his diagnosis, I have shared with Tom the various guidelines such as changes in American Diabetes Association (ADA) guidelines for diagnosing diabetes and prediabetes. His daughter had an oral glucose tolerance test for gestational diabetes during her last pregnancy and he had questions about that. He finally understood the need for a glucose load (versus an FBS), the implications of gestational diabetes, and was able to reassure her.
We have also talked about why HBA1C is used to monitor long term glucose management. Tom is used to monitoring his glucose daily and to feel pretty good if his HBA1C is below 7% as recommended by his physician.
His question to me recently was why a physician was concerned with Tom's younger brother's HBA1C value of 6.4%. Why did he order this test on a non-diabetic, anyway? Tom asked. Isn't HBA1C a test to monitor diabetics?
I told him that the ADA used to have a firm stance against using HBA1C to diagnose diabetes due to great variability between labs.
However with improved technology variability is less and in 2010 the ADA reversed its stance and now recommends that a person with a HA1C of 6.5% or higher be considered diabetic, while a value of between 5.7 and 6.4% is considered prediabetic. Tom's brother would therefore be prediabetic at best and possibly even diabetic; although his doctor did not explain tat very well.
I suggested that he ask his physician for a repeat test at a minimum.
The take way for me was how complex all this must sound to a lay person and also how important it is for us as professionals to keep up to date and be able to clearly articulate what all these tests and numbers mean. We need to be resources not just for patients but for physicians and nurses as well. I still see lab results with reference intervals for glucose up to 110 mg/dl and no interpretation given for HBA1C levels.
We need to do better.