Items in Caring Currents tagged with Diabetes

Prevent Diabetes By Treating It Before It Starts

Melanie Haiken — Fri, 16 Oct 2009 07:00:00 -0000

It can be really scary when a doctor tells you that you have pre-diabetes, or that the results of a glucose test show you're at risk for diabetes. Pre-diabetes is diagnosed when blood glucose is between 100 and 125 mg/dL or when a glucose tolerance test shows the glucose in your blood to be between 140 and 199 mg/dL. But too many times this news is presented in a passive way -- as if it's just something you have to live with.

Actually, studies show, pre-diabetes is just that -- a sign that your body is on the way to getting diabetes. And just as you can lower blood pressure or cholesterol that's in the high normal range, you can prevent diabetes by taking steps to keep it at bay.

To start with, analyze the top risk factors that could be putting you at risk for diabetes. If you have two or more of these risk factors, diabetes could be on the horizon for you, and you might want to pay attention to all strategies that work to protect against it.

Top 6 Diabetes Risk Factors:

• Being overweight -- A body-mass index of 30 or above vastly increases your risk of diabetes, but even being moderately overweight (BMI over 25) -- particularly in the belly area -- is a risk factor.

• Having "pre-diabetes," which means having higher blood sugar than normal.

• Being insulin resistant -- This is usually determined when doctors diagnose other conditions, such as metabolic syndrome. (Metabolic syndrome is the medical term for having several cardiovascular risk factors: high blood pressure, high cholesterol, high triglycerides, and excess weight around the waist.)

• Being sedentary -- Even moderate activity reduces the risk of diabetes by helping regulate insulin.

• Having a family history of diabetes -- A first-generation relative (parent, sibling, or child) with diabetes increases your risk; this unfortunately is one risk factor you can't control.

• Being of Hispanic, African-American, or American Indian descent - obviously you can't prevent or change this one either.

• For women, having had a baby over nine pounds at birth, or having been diagnosed with gestational diabetes.

How To Treat Pre-diabetes

In a nutshell, you treat pre-diabetes like it's diabetes itself. Except -- most likely -- you're not already suffering the degenerative disabilities that come with diabetes, such as nerve damage and vision problems. And you don't want those, right? In that sense, pre-diabetes is good news. Think of it as a call to action. Here's what you do:

1. Lose weight - even a little bit. Studies show that someone who weighs 200 pounds can prevent diabetes by losing just 10 to 15 pounds. But without that weight loss, most people with pre-diabetes will be diabetic within five to seven years.

2. Treat insulin resistance. The first-line drug of choice is metformin (brand names Glucophage, Fortamet), which stimulates the sensitivity of cells in the liver and other tissues to increase the uptake of glucose.

3. Get moving. Instead of thinking of it as exercise, which feels like a duty, think of ways to get your body in motion. Gardening, walking the dog, doing chores around the house -- anything that's not sitting on the couch benefits your body by stimulating heart rate and circulation. Aim for 30 minutes a day, even if it's in three ten-minute bursts.

4. Lower blood pressure and LDL ("bad") cholesterol and boost HDL ("good") cholesterol. This can involve taking a statin, a diuretic, or other meds, or it can be achieved through diet, weight loss, and exercise.

And here's a motivating thought to make this all worthwhile: Two big studies published in the last few years have shown that people with pre-diabetes who followed the recommendations above cut their risk of getting diabetes by more than half.

Stress and the Music Cure

Paula Spencer — Wed, 22 Jul 2009 07:00:00 -0000

Music can't make the demands of caregiving go away, but it can make you more healthfully equipped to plow through those demands. Music therapy is a fascinating and growing field, and you don't have to be the person who's sick to benefit.

In June, the inaugural conference of the International Association for Music and Medicine explored the countless ways tunes can help heal, whether you're recovering from surgery or cancer, coping with grief, having a baby -- or caring for an aging relative.

I saw this in action just last week. My 87-year-old dad is currently in a rehab facility recovering from a small stroke. Because he also has dementia, he's living in a specialized dementia/Alzheimer's wing of the facility. I'd brought my teenage son for a visit -- and he in turn brought his acoustic guitar to entertain his Grandpa. Before we reached my dad's room, the nurses spied the instrument.

"A guitar! Will you play for everybody? Please?"

Before he knew it, my son was standing in the lounge, jamming in front of the entire population of the 20-bed wing. I was really proud of him (he used to resist command performances, and this was, of course, no everyday audience for a teenager).

But it's what happened next that was the real miracle: The collective mood lifted, for patients and nursing staff alike. There were broad smiles. There was rhythmic clapping, and even some enthusiastic dancing. Unresponsive residents perked up for the length of a song. The inattentive grew still and watched closely. And the collected nurses, assistants, and aides -- ordinarily pleasant but mostly harried and businesslike -- seemed to unwind before my very eyes. "Wow, that was re-energizing. I can make it to the end of my shift now," one told me.

And why not? Aside from the benefits of music therapy for people with dementia, which I've written about before, it's worth noting the effect of music on caregivers. Music is the language of the soul. It's been shown to impact mind, body, and emotions -- the same multi-pronged targets that stress attacks. That's why enjoying music is so effective, whether your being is stressed by having a disease like Alzheimer's or by taking care of someone who does (or who has some other care needs).

Music isn't a magic wand that will vanquish the circular stress of feeding and bathing and worrying about a relative. But it does seem to have the power to transform hard moments into easier ones -- and I'll take that.

Some music ideas for caregivers:

* Find music you and the person you care for both enjoy. People with dementia, for example, often respond well to music from their teens and 20s, which taps deep-set memory tracks. Experiment. You might discover you groove on big band music. But don't completely ignore your own favorites: Expose a parent to Dave Matthews or Michael Jackson, and you both might find some common ground.

*Create a "bad day playlist." Make a CD or track of nothing but your most soothing favorites. Save it for high-stress days. Help a fellow caregiver: Create and publish your personalized iMix at the iTunes Store. (Picking your songs for the playlist and arranging them can be as soothing as listening to them.)

*Sing along. Or dance. The more interactive you are with the music, the more deeply your response to it.

*Find the music your mood needs. At last month's music and medicine conference in Ireland, one of the music therapists involved pointed out how Irish music comes in three main types: the lullaby (suantraí), the music of happiness (geantraí) and the music of sadness (goltraí). These categorizations are useful.

Just as you should pause to think about what kind of food you really want when you're hungry (protein? fruit? something salty?), give some consideration to the type of tunes you need. Where do you want the music to lead you?

Alzheimer's Aggression Is Scary, But You Can Get Through It

Paula Spencer — Thu, 15 Jan 2009 08:00:00 -0000

Hitting. Kicking. Grabbing. Pushing. Cursing. Biting. Throwing. Scratching. News this week about these explosive and combative behaviors that can appear in someone with mid- to late-stage Alzheimer's underscores just how challenging they are to deal with. (Although I admit, describing these incidents as a "challenge" is like calling a war "a slight disagreement.")

Proof you're not alone:

Aggression can be frightening. More than one third of Alzheimer's caregivers have observed aggressive behavior, finds a new survey from the Alzheimer's Foundation for Caregiving in Canada (AFCC). Almost one in four caregivers is scared or feels threatened by such incidents.

Caregivers don't feel free to discuss it. Two-thirds of caregivers felt free to discuss symptoms like disorientation and mood swings with people outside their immediate family, the AFCC survey also found. But just over half were willing to talk about aggressive acts.

As a social worker once told me, "Memory loss has become socially acceptable but aggressiveness still carries a stigma – it's the shameful secret burden of dementia caregivers."

Drug treatments are dangerous. Last week's Lancet Neurology reported that people with Alzheimer's who are prescribed antipsychotic drugs to treat aggression have a much higher risk of death after two years. The drugs included thioridazine, chlorpromazine, haloperidol, trifluorperazine and risperidone. Though widely used, especially in nursing homes, these meds aren't FDA-approved for use with dementia. Their "off label" use (legal but not approved) is considered a last resort -- moreso since a spate of similar research in the past year.

Where does that leave you? Seven words that help:

Separate. Don't take outbursts personally.
Breathe. Switch your focus from the behavior to your reaction. Keyword: Cool. Showing anger or arguing might make you feel momentarily better but it's like throwing oil on flame.
Safeguard. Step backward to avoid getting hurt if you need to. Resist using force unless the person is about to harm himself.
Empathize. Focus on the person's feelings, not their actions. Frustration over something they can't communicate is a common root of hurtful behavior.
Track. Surprisingly often there's a pattern to what triggers outbursts. Write down what was happening right beforehand: activity, mood, the conditions of the room, time of day. Crack the code and you can reduce or sometimes eliminate the problem.
Share. Don't let embarrassment keep you from opening up about these tough incidents -- to your relative's doctor, a trusted friend, or other dementia caregivers. (Especially other dementia caregivers.) What drives you crazy? What works? Share.

Why You Should Care About Diabetes

Sarah Henry — Fri, 14 Nov 2008 08:00:00 -0000

More people fear a shark attack, plane crash, lightning strike, or snake bite than developing diabetes. Clearly, our fears don't match reality. There's a diabetes epidemic, folks, but -- last I checked -- only a few unfortunate souls were felled by any of the above.

Alas, diabetes denial is not reserved for the undiagnosed. If you're caring for someone with type 2 diabetes, you may encounter resistance to recommended lifestyle changes that can keep diabetes complications at bay. Or this disease may take a backseat to other medical concerns such as Alzheimer's, stroke, or a broken hip. Perhaps the diabetes has already done significant damage. Or maybe he simply ignores the disease.

Whichever camp you fall into, since we're in the middle of American Diabetes Month, I thought this a good time to do a roundup of recent diabetes-related headlines.

Here, reasons readers should be concerned about diabetes -- and suggestions for how to handle the condition.

First, let's do the numbers.Every year, nine out of every 1,000 American adults are newly diagnosed with type 2 diabetes. That's up from just five in 1,000 from a decade ago, a worrisome leap. What it means: If you or the person you care for are at risk for the disease, get tested. Consider making lifestyle changes to avoid the disease.

Having diabetes or high blood pressure may hasten the death of people with Alzheimer's disease, suggests new research. It's too soon to draw a definitive link here, but it's becoming increasingly clear that diabetes and Alzheimer's is a troubling combo. What it means: Another reason to keep blood sugar and blood pressure in check.

Newer diabetes drugs have fallen under scrutiny. In the past year, safety concerns have surfaced about the non-insulin injectable exanatide (brand name: Byetta) and the oral meds sitagliptin (Januvia), and rosiglitazone (Avandia). What it means: Talk with a physician about medications if you have concerns about a drug's safety or side effects. Use caution when considering adopting newer drugs for the elderly, advises geriatrician and Caring.com expert Leslie Kernisan.

In a consensus statement on blood sugar control, doctors were advised to keep the individual in mind when weighing the benefits and burdens of so-called tight control in people with a limited lifespan. While an A1c test result less than 7 percent is recommended for the general diabetes population, a reading under 8 may be acceptable -- and more realistic -- in the frail elderly, says Kernisan. What it means: Check with the person in your care's doctor about what blood sugar range makes sense for him. Ask: Should I be concerned about his diabetes, given his overall health? How well is it controlled? Would he benefit if it was under better control?

Eaten twice a week, fish could fight off kidney disease, a diabetes complication, suggests a large European study, though it's too soon to make dietary recommendations based on this data. What it means: Maybe more incentive to include fish, a good source of protein and omega-3 fatty acids, in a healthy diet, which is key to diabetes care.

A review of the medical literature indicates that the relatively inexpensive, older, oral diabetes drug metformin may do a better job reducing heart disease deaths than newer, pricier pills. What it means: Consult with a physician about medication choices.

What else can you do to help the person in your care?

Keep diabetes in mind, even with multiple diagnoses. "No matter what other conditions a person may have, if glucose is too high -- consistently 200 milligrams or more per deciliter of blood -- a person will feel worse," says diabetes educator and Caring.com expert Theresa Garnero. That said, sometimes diabetes does play second fiddle to other diseases. "It's up to a skilled practitioner to look at the most pressing issue, ask what the family or patient is willing to do, then support their efforts," says Garnero. "We need to look at the whole person."

Consider lifestyle changes. Encourage the person you care for to get active, eat well, quit smoking, cut back on alcohol, and reduce stress. These can all keep blood sugar in check and help avoid complications and improve overall health.

Find a diabetes educator. These professionals can help you navigate the bumpy terrain that comes with a diabetes diagnosis. If you can find a diabetes educator who has experience with seniors, all the better.

What's missing from this list? Chime in with your thoughts.

Photo by Flickr user Kecko used under the Creative Commons Attribution license.

Facing the Fear: How Do We Talk About It When Cancer Spreads?

Melanie Haiken — Wed, 29 Oct 2008 07:00:00 -0000

Talking about cancer the first time is hard enough. Sharing the demoralizing news that cancer has progressed or recurred is an altogether different kind of hard. How do you gather your courage and keep going -- and continue talking about it -- when the scans show new metastases turning up in your spine, your brain, your lungs, your liver?

This is what happened to one of my favorite bloggers, Jeanne Sather of The Assertive Cancer Patient, this week. She wrote about it bravely in her post Tykerb Fails! Jeanne's perspective -- that this is a time to regroup, focus on herself, get lots of tests, and figure out what to do next -- is healthy and admirable and, most of all, we wish her well.

Guidance from One Who's Been There

I urge everyone in cancer world who's struggling to cope with the ever-changing and exhausting roller coaster of metastatic cancer to read a new book by minister Forrest Church, Love and Death: My Journey Through the Valley of the Shadow. The son of the famous senator by the same name, Church (whose photo appears above) has been the Unitarian-Universalist Minister of All Souls Church in New York for 30 years. Diagnosed with incurable esophageal cancer exactly two years ago, he was given a prognosis of three to six months to live. (This is the same cancer and same prognosis my own father received.)

Successful surgery to remove his esophagus bought Church a period of health, but in February of this year, his cancer came back with a vengeance, and he was given a prognosis of just a few months to live. He's been living -- and preaching and writing -- in that shadow ever since, and his meditations on living with that uncertainty will prove incredibly helpful to anyone caring for a loved one with metastatic cancer. There's a great article by Church summing up some of the thoughts that are more expansively presented in his book.

Church was interviewed yesterday by National Public Radio's Terry Gross. It's very moving and made me feel so much love and respect for all of us struggling to live and love in cancer's fearful shade.

Seeking Solace Through Sharing

At Caring.com, questions about metastatic cancer come in all the time, and one of the things they make clear is that we shouldn't feel badly that we have a hard time discussing it, because it's equally difficult for doctors to talk about it. Doctors have such a hard time, in fact, that they seem to avoid the subject even when it's the "elephant in the living room," staring everyone in the face. One Caring.com member, Jo182 wrote that her father had been given a diagnosis of Stage IV colon cancer and was bedridden, and all she wanted to know was whether his case was terminal, so she could spend as much time with him as possible and begin the process of letting go.

For those who'd like to hear from others caring for parents and other loved ones with end-stage metastatic cancer, there are several discussions ongoing at Caring.com, and I invite you to seek support here. I'd also like to recommend as a resource the blog Metastatic Liver Cancer. It's a place people go who're struggling with very difficult issues, and while some of it's difficult to read, it's also inspirational to see how families are supporting each other through tough times.

Image of Forrest Church taken from video footage on NPR.com in public domain.

Just Diagnosed With Diabetes: Now What?

Sarah Henry — Thu, 16 Oct 2008 07:00:00 -0000

In her 20-year nursing career, award-winning, certified diabetes educator Theresa Garnero, a Caring.com expert, has helped thousands of older adults newly diagnosed with the disease. Theresa has devoted the past 10 years exclusively to diabetes care.

No need to just take my word for it, the uber-respected diabetes blogger Amy Tenderich sings her praises, too, in a recent post titled The Diabetes Educator We All Should See.

Ever since she started tackling this disorder, Theresa has been on the lookout for a useful diabetes guide for the newly-diagnosed, one that could help them manage this complex, often overwhelming, condition in a day-by-day interactive way -- with a little levity to offset the doom-and-gloom that so often accompanies a diabetes diagnosis. Frustrated that nothing like that was available, she teamed up with the American Diabetes Association to pen the just-released Your First Year With Diabetes: What To Do, Month by Month.

The guide is much like Theresa herself: practical, no-nonsense, and easy-to-follow, full of straightforward advice and tips, her own quirky cartoons, and a healthy dose of humor. Best of all -- for folks with the disease and caregivers alike -- every chapter contains a couple of nifty personal health checklists, each broken down into small steps people can take to help manage the disease. And, at month's end, there's a review sheet for summing up changes that have been succesful (or, um, not) to help keep track of -- and reward -- progress, or to refocus or recommit, as needed.

Theresa knows just how hard it is for older adults to change their ways. "You have better luck changing their religious practices than their eating patterns," jokes the self-described diabetes junkie-slash-health entertainer. "But making even modest adjustments could add years to their life. I try to show them how to put those good intentions -- 'I will eat better or exercise more' -- into play."

She advises busy caregivers pressed for time to skip over the science in the book (if they must) and simply head to the checklists as a way of connecting with a family member by finding out (and, equally important, following up on) what that person is willing to do to take charge of her health. If time permits, she says, you can always go back to understand the "why" behind the advice.

Case in point: exercise. Here's an excerpt from the book, so you can get a sense of how it works:

Day 16: Every Step You Take

Personal Goal

Today (date), I decided I can (check one):

Buy a pedometer and measure the number of steps I take every day.
Stretch before I walk. Start a program of 10 minutes of brisk walking three days a week.
Gradually increase the amount of steps I take on a weekly basis. Increase to 30 minutes of walking per day at least five days a week.
Walk while running errands rather than relying on my car.
Check out www.americaonthemove.org to find activities in my community.
Write my daily steps on a calendar, so I can watch my progress.
Don't quit if I miss a few days.

Need added inspiration for living well with diabetes for a long time? Look no further than this month's Diabetes Forecast, which features six people who've survived and thrived with diabetes for more than six decades.

So don't wait until a complication like vision loss or nerve damage or stroke forces change upon your family member with diabetes. Instead, encourage the person you care for to make modest lifestyle adjustments, so she can turn diabetes into a controllable condition rather than a debilitating and disabling one.

And while you're at it, inject a little fun into the proceedings. As Theresa likes to point out: Diabetes may be no laughing matter, but a good belly laugh may lower glucose levels. Now, that's something to smile about.

Book excerpt by permission of the author, Theresa Garnero.

High Blood Pressure, High Cholesterol, Diabetes -- and Cancer?

Melanie Haiken — Wed, 15 Oct 2008 07:00:00 -0000

The annual meeting of the American College of Gastroenterology featured a presentation by researchers who found that those with metabolic syndrome -- a cluster of conditions including hypertension, high cholesterol, and diabetes or pre-diabetes -- were 75 percent more likely to develop colorectal cancer as those without this condition. (Patient education materials about metabolic syndrome often emphasize caution if you're an "apple" shape, because abdominal fat is a major clue to this condition.)

People with metabolic syndrome are already considered to be at higher risk for heart disease and stroke, so this merely adds to the list of things we need to be concerned about if those we're caring for are overweight or obese and suffer from these related conditions.

Using data on 58,000 people collected during the annual National Health Interview Survey, a team led by Donald Garrow and Mark Delegge of the Medical University of South Carolina in Charleston found that out of 1,182 people who met the criteria for metabolic syndrome, 350 reported a history of colorectal cancer. After controlling for factors such as age, gender, race, obesity, smoking, and alcohol use, researchers found this translated into a 75 percent higher risk than among the total population.

Experts already knew of the connection between metabolic syndrome and colon cancer, but previous studies had been much smaller and less definitive. The researchers released the results with a plea to doctors and patients to make sure those who suffer from metabolic syndrome receive regular screening tests for colorectal cancer.

This follows some other big news just a few days ago that the government has issued new guidelines for colorectal cancer screening.

These are:

A fecal occult blood test --- a test for hidden blood in the stool -- once a year:
flexible sigmoidoscopy -- an examination of the lower colon and rectum with a lighted scope -- every five years
colonoscopy -- an examination of the entire colon with a lighted scope -- every ten years

In addition, the government also recommends:

A double contrast barium enema: X-rays of the colon and rectum enhanced with a barium enema -- every five years
Or a virtual colonoscopy (computed tomographic colonography) -- a 3D x-ray of the colon -- every five years

In another newsmaking development, the new guidelines recommend against regular screening for those age 75 and older. This is because experts have concluded that the risks outweigh the benefits among the elderly, in whom cancer grows much more slowly.

So now we have an interesting dilemma, given the news about the risk from metabolic syndrome. Personally, if I or someone I'm caring for were over 75 and had metabolic syndrome, given these findings I'd want to continue screening for cancer. Certainly this is something to discuss thoroughly with your doctor.

Image courtesy of Flickr user Andreas Kolleger used under the Creative Commons Attribution License.

Tough Times Can Turn Seniors into Bargain Hunters

Stephanie Miles — Fri, 05 Sep 2008 07:00:00 -0000

The tough economy is forcing more seniors than ever into bankruptcy, according to a new report, and leading many older people to seek out -- and find -- bargains and discounts available only to them.

In 1991, people 55 years old and up accounted for about 8% of bankruptcy filers, but by last year this group accounted for 22% of all bankruptcies, according to the report by the Consumer Bankruptcy Project.

"While the bankruptcy filing rate for those under 55 has fallen, it has soared for older Americans," according to a USA Today article. "The older the age group, the worse it got — people 65 and up became more than twice as likely to file during that period, and the filing rate for those 75 and older more than quadrupled."

Seniors -- especially those on a fixed income -- are being hit disproportionately hard by factors like the rising costs of consumer goods and gas, not to mention soaring medical expenses, the study concludes. In the face of increasingly tight budgets, many seniors are finding new ways to save money on daily expenses -- including turning to a host of Web sites dedicated to hunting down bargains and deals especially for older adults.

Rebecca Warren, a certified financial planner writing for the East Valley Tribune in Phoneix has compiled some of her favorite bargain hunting sites for seniors. These include:

TodaysSeniors.com, which offers money saving tips as well as hunts down available senior discounts on car insurance, dental care, diabetes supplies, groceries, travel expenses, Internet access, magazines, restaurants and warehouse clubs.
About.com's Frugal Living Guide, which includes local discounts and a free newsletter.
The Frugal Shopper, which offers a complete list of seasonal sales. For example: October has the best deals on cars while linens are often on sale in May and August
Senior Something.Com, which also compiles money saving tips and senior discounts.

Even if the store, restaurant, or hotel your parent patronizes doesn't advertise an official senior discount, many businesses will happily cut 10% off the advertised price -- if asked -- to keep a regular customer happy. As she points out: it never hurts to ask!

Photo by Flickr member The American Roadside, used under the Creative Commons Attribution License.

Diabetes Doughnut Hole Dilemma

Sarah Henry — Thu, 04 Sep 2008 07:00:00 -0000

There's nothing sugary about this news. Last week fellow blogger Stephanie Miles reported on the catchily-named but confusing "doughnut hole," a coverage gap in Medicare Part D prescription drug benefits that choked millions of seniors last year by forcing them to pay full freight for prescription drugs they had been getting cheaply. Faced with this out-of-pocket expense, a sizable chunk of them simply stopped their treatments.

The elderly with chronic conditions are often hardest hit by the doughnut deductible -- this year capped at $4,050 for out-of-pocket costs -- and those with diabetes are no exception. About 10 percent of people with the disease stopped buying their drugs in 2007, according to the report. For those who do keep paying, finances can get pretty tight. Dick Robbins, 72, ponied up $300 a month with Medicare's help for diabetes drugs and syringes -- and up to $800 a month during the doughnut hole period, according to a recent Health story.

The New York Times weighed in this week with an editorial pointing out that skipping prescription meds could cause both immediate and serious consequences for those aging with diabetes. Earlier this year, a study presented at the American Diabetes Association annual conference showed seniors with diabetes who use insulin and don't have gap coverage hit the doughnut hole about 6 or 7 months after enrolling. Of those, almost half stayed on their diabetes drug regimen, but almost one-quarter dropped one or more drugs (usually for the balance of the year); 16 percent dropped all diabetes drugs; and 13 percent began a new drug. What this data didn't show is whether some of those who dropped meds started on different ones. Still, the findings are worrisome.

What to do?

Check out the resources listed in last week's blog to figure out coverage options to make sure your parents can keep paying for diabetes drugs.
Review their drug plans' monthly payment notice, which should include information on how close they are to the gap.
Help them switch to a different Medicare Part D drug plan during the open enrollment period between November 15 and December 31, if it means they'll get better coverage.

The bottom line here: Don't let a loved one get caught short. As one person dinged by the doughnut hole noted in reply to a Wall Street Journal post on the subject: "Ninety percent of seniors never heard of the doughnut hole until they go to the pharmacy, where their jaw drops as they're told that their benefits are suddenly up and they themselves have to pay several thousand dollars out-of-pocket before the plan's coverage kicks back in. Ask your own mother or grandmother if you need further evidence!"

Sound advice. And to keep it sweet: Find out if and when the doughnut hole eats into your family member's finances so you can plan ahead to prevent necessary prescription diabetes medications from breaking the budget.

Image by Flickr user Charles Haynes used under the Creative Commons attribution license.

Diabetes A1c Test: New Use for an Old-Line Tool

Sarah Henry — Thu, 28 Aug 2008 07:00:00 -0000

Last week I wrote about how the A1c test, the current gold standard for monitoring long-term blood sugar control in people with diabetes, may soon be replaced by a new measure, the estimated average glucose (eAG) test.

Now it appears the old A1c test may be put to new use. A team lead by an edocrinologist at the Johns Hopkins University School of Medicine is recommending that the A1c measure be used to identify potentially millions of people with undetected diabetes.

Current diagnostic tests designed to detect diabetes are limited, according to the team, as they only measure the amount of sugar present at the time a blood sample is taken. The A1c doesn't require a person to fast overnight, another significant advantage over both currently available screening tests: the oral glucose tolerance test and the fasting blood glucose test.

Diabetologists suggest the current screening tests may miss a significant portion of the population that has diabetes or is at high risk of developing the disease, since glucose levels can vary depending on a person's diet and activity for several days leading up to a blood draw. (And, let's be honest, who's going to admit to trying to skew results by skipping doughnuts and ice cream and taking a brisk walk in the days leading up to a sugar check?)

This national panel recently recommended that folks who score a 6 percent on an A1c test may be at risk for diabetes and should be followed closely. Those who hit 6.5 percent or higher should be considered to have diabetes, if a subsequent check confirms initial test results. Among seniors 70 and over, some geriatricians say shooting for a slightly higher A1c, around 7.5 percent, is more realistic. (And in the frail elderly, that number may climb even higher, depending on an individual’s other health concerns and whether or not diabetes-related complications are a factor.)

Speaking of shifting numbers -- exactly when diabetes is diagnosed and in whom -- is the subject of an eye-opening post by David Cliff, who has type 2 insulin-dependent diabetes, and blogs about the big business of diabetes at the Diabetes Investor. (His insights on the whole quandary about use of the term "pre-diabetes" is particularly illuminating, especially for anyone with numbers hovering in that gray zone.) And he weighs in wittily on the whole A1c vs. eAG debate.

Of course, all this talk about 6s and 7s begs the question: What's a person to do if he or she is concerned about being at risk for diabetes? Simple, ask a physician about the benefits of taking an A1c test instead of standard screening checks.

Whatever screening measure you and your doctor decide to use, don't wait to be tested. The sooner you find out if you have the disease the sooner you can take steps to prevent its brutal complications, which can damage the body from head to toe.

Image by Flickr user kr4gin used under the Creative Commons attribution license.