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Is It time to change your diabetes monitoring strategy?

My routine patient, Ajay Keshwani, 49, is very regular in getting his sugar levels tested. He even maintains a record of readings in a chart format; just to be sure he gets it done on the same time every month. Mostly he gets postprandial (post meal, PP) levels because it is convenient for him to come to the lab in the lunch hours.

Sometimes he gets fasting and random sugar tests also. That’s not too frequent because fasting time it’s not convenient to come early morning and for random he gets it done when he returns from his office. He has been following this routine check-up since 1 and half year when he had been diagnosed with diabetes.

Ajay realized that his sugar readings always fluctuate in the three conditions of post meal, fasting and random. Though he had following a strict treatment regime and his sugar levels were in an acceptable diabetic control range, he wanted to review it again. I asked him to come with all his readings to me. His records were maintained very well in a chronological manner with 3 charts – Fasting / PP / Random.

Going through his charts, it showed a very frequent variation in PP, not so frequent in Fasting and totally absurd readings in Random. I asked for some other report like HbA1c (Glycosylated Hemoglobin). “HbA1c! What’ that?” he responded. “I have never got it done, no one actually asked me to get it done for that matter. Of late, I didn’t visit my physician also because the sugar levels were not alarming enough.” I told Ajay that HbA1c is your report card of how well you have maintained your treatment regime and its also a reflection of how well your physician has treated and educated you.

We got his HaA1c done – it showed 7.1 which meant that he had things under control and his treatment was working. Ajay was lucky to have a good health status despite being careless to review his readings! But it might be different for some other patients.

Many patients just see their sugar readings and continue treating themselves with the same medicines prescribed at the time of diagnosis. They have no idea on how to know if long term treatment is working or not. They don’t know that there is a report card to assess the treatment.

HbA1c is a haemoglobin with an attached sugar molecule. This attachment happens when the Heamoglobin is formed. Normal lifespan Haemoglobin is 180 days, so if we measure it we shall know sugar changes in the last 3 months. Blood glucose reflects the sugar level of only the present moment; HbA1c gives fair idea of a long term.

Diabetic associations around the world recommend getting it done every 3 months. HPLC is the best method commercially available for the test. The target HbA1c level for a good control is 7%. If it is more than 8%, you are not doing well. It’s been shown that having an HbA1c below the recommended target reduces the risk of developing diabetes-associated complications, such as stroke, heart attack, nerve damage or damage to small blood vessels in the kidneys and eyes.

To understand it better -

- If its < 6% it can be non-diabetic, 7% is Goal, >8% action needed like review medication + alter lifestyle + tight diet control

- It is must for all diabetic patients to get it done once every 3 months.

- It can tell if you are pre-diabetic.

- It is the best marker for long term diabetic associated complications.

If your HbA1c is not in the ideal range, don’t panic! Speak to your diabetes educator or Physician about strategies to improve your control.

Dr. Vinay Tiwary, the director of Tiwary Clinical Labs, is a doctor by profession and a runner by passion. Having completed his MBBS and MD from prestigious institutions, he did a Diabetic Educatorship fellowship to up skill people’s knowledge of diabetes. Dr. Tiwary believes that running is a natural instinct of human. “Running is easy and pleasing, when we are happy we run towards our loved ones. It’s in our instinct.”, he says. He is also the founder of Let’s Run, a unique community of runners in Raipur.
Connect to your hero Vinay at dr.vinay@tclonline.in

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