Monday, January 3, 2022

The Start Of A New Health Battle For 2022 - Against Diabetes


                               My late younger brother, Johnny, about 5 weeks before he died owing to cardiac complications arising from his diabetes. Note his closed eyes. He'd been dealing with blindness from diabetic retinopathy.

As the latest a1c test result delivered the news:  a reading of 6.5% and the referring physician's warning of "diabetes onset", the blood drained from Janice's face and mine.  We had received the script test results a day before Christmas Eve when a dear friend was about to deliver her regular Xmas gift: a delicious home made apple pie. (For which we had already purchased the vanilla ice cream to have with it.)  But this sudden and undesirable news meant the holiday fare planned  would have to be radically changed.  

The preferred way to screen for diabetes  is with the a1c  blood test.  This can often be easily done with just a fingerstick in the dr's office but I had it done in early December as part of a panel of unrelated tests (requested by my urologist) which included: PSA, hematocrit and testosterone.   Just as well as I found the hematocrit (marking degree of blood clotting) had gone down to 54% from 63% (near stroke level), and the testosterone had gone up to 203 from 110.  The PSA remained about the same at 8.3.   (Actually up a bit, 0.3 ng/dl  - likely from the slight increase in testosterone - which is the main fuel for prostate cancer.)

To fix ideas, the a1c measures   the percentage of hemoglobin in your blood that carries glucose. The higher the amount of glucose in the blood the higher the a1c percentage.  A normal a1c measurement is less than 5.7% - while an a1c of 5.7% - 6.4 is regarded as prediabetes,    An a1c of 6.5% or higher usually means diabetes, so I am right on the cusp of the disease, if indeed a 2nd test confirms it.

The main takeaway and primary positive from the a1c is that generally TWO tests are needed to confirm it.  Hence, the urologist has scheduled a new year appt. for Feb. 22nd at which time we will go over the existing tests and I will also get another a1c.  This will give me two months to see about changing the verdict, which I suspect might have been excessively high from the get go (up from 5.8 in May)

In the meantime I am going to assume the single test is accurate, especially as I've not had the best eating habits the past 4 months (including partaking of Janice's pandemic baking!),

 As I've written in previous posts, diabetes runs in my family:  my beloved maternal grandmother died from it, and all 3 younger brothers battled it using a battery of meds (e.g. Metformin) as well as insulin injections.  My youngest brother, Mike, needed 3 different meds to control his numbers and one VA doc conjectured this may have led to his liver cancer - that finally killed him in June, 2018.   My middle brother John (see photo) , was dogged with diabetes for years, finally ending up with blindness from diabetic retinopathy then cardiac problems, and finally kidney failure and brain death on May 6, 2013.  

My own plan to combat the disease - if indeed I am on the cusp of it- is to first increase my walking to 150 mins. a week, from the current 65-70.  Next, I have totally cut out the 'Farmhouse'  bagels from Einstein Bros. Bagels (right down the road) three times a week. They are terrific but loaded with 680 calories of which 32 g are fat, and 64 g carbohydrate.  Thus, a total of over 2,000 extra calories have now been excised  of which 196 g comes from carbs - one of the main culprits fueling diabetes.   

In place of the farmhouse bagels for breakfast I am now having two scrambled eggs with Maitake mushrooms, with two lean turkey sausages. Oh, and a small orange.  Roughly half the calories of the bagel and zero carbs. (Apart from the 40 or so from the orange.)

Of course, the other part of this is that Janice will have to cut back on all her pandemic  baking (pies, cranberry scones, blueberry muffins, strudel, cakes etc.) which has happily occupied her during the last two years.  Also, we had our friend make us just a "mini" apple pie this time (6 inch dia. instead of 14 inch) and with half  the sugar.

Historically, there have been  two approaches to measuring a1c. One approach is to separate A1c from other hemoglobin fractions and includes methods such as chromatography and electrophoresis. The other approach targets a1c as an antigen using methods such as immunochemistry.

Within this context, the four most commonly used methods to measure A1c are ion-exchange  high-performance liquid chromatography (HPLC), boronate affinity HPLC, immunoassay, and enzymatic assays.  Alas, the variety of assays and methods used to measure a1c have led to a lack of standardization, which has limited the ability to reliably compare treatments across clinical practices.  One hopes this will soon improve and one way may be by reporting test results in both systems, i.e. both as a percent of glucose- bearing hemoglobin in blood and via International Federation of Clinical Chemistry (IFCC) - derived SI units (millimoles of a1c per mole of HbA)  Fortunately there is a "master" regression equation available for converting values between the two systems.  Notably, the IFCC and the European Association for the Study of Diabetes (EASD) supports using both systems.  

I definitely agree.

Diabetes, given the havoc it can wreak on nearly every organ - while also being an insidious killer - is nothing to play around with.  It is also exploding in this country as poor eating choices abound.  Given the cost of the drug insulin has also exploded, becoming a type II diabetic is definitely something to avoid.  If a test - even one-  indicates it,  that means doing all in one's power to control it.  Something my brother Johnny learned too late.

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