WHAT KIND OF GLUCOSE TEST SHOULD A PERSON ASK OUR DOCTORS TO TEST FOR DIABETES? IS IT COVERED BY INSURANCE?
Two tests are commonly used to screen for diabetes—a fasting glucose test, or an A1C test. Both are routinely covered by insurance.
WHAT IS THE A1C TEST AND WHY SHOULD PEOPLE GET IT?
The A1C test is used both for screening for diabetes and for monitoring how well diabetes is being managed for a person who has diabetes. For measuring diabetes management, an A1C is usually done twice a year, or four times a year if changes in treatment are being made to bring diabetes under better control.
WHY DO DIABETES BLOOD TESTS RESULTS VARY?
Speaking just of the A1C test, it’s generally a very stable and reproducible test. It measures the amount of glucose attached to red blood cells in the body, so anything that affects the number of red blood cells in the body—such as the sickle-cell trait—can skew the A1C test. ADA advises doctors to look out for these issues in individual patients.
CAN DIABETES BE REVERSED?
Diabetes can’t be reversed, but some patients with type 2 diabetes are able to manage their diabetes through lifestyle changes (diet and exercise) to bring blood glucose levels back to the normal range. Diabetes is a progressive disease, so most patients with type 2 diabetes generally need to use medications at some point to keep diabetes well-managed.
WHAT IS A HEALTHY GLUCOSE LEVEL?
Blood glucose targets are individualized based on:
- Duration of diabetes
- Age/life expectancy
- Comorbid conditions
- Known cardiovascular disease or advanced microvascular complications
- Hypoglycemia unawareness
- Individual patient considerations
The ADA suggests the following targets for most non-pregnant adults with diabetes. More or less stringent glycemic goals may be appropriate for each individual.
- A1C: Less than 7%
- A1C may also be reported as eAG: Less than 154 mg/dl
- Before a meal (preprandial plasma glucose): 80–130 mg/dl
- 1-2 hours after beginning of the meal (Postprandial plasma glucose)*: Less than 180 mg/dl
Postprandial glucose may be targeted if A1C goals are not met despite reaching preprandial glucose goals.
WHAT FOODS SHOULD PEOPLE WITH DIABETES FOCUS ON WHEN AT A FAMILY/COMPANY GATHERING?
No foods are off-limits for people with diabetes. People with diabetes should talk to their doctor, a diabetes educator, or a dietitian about finding a food plan that they can follow that includes the foods they enjoy. Most often people just need to be careful about portions rather than avoid certain foods altogether.
WHAT WARNING SIGNS SHOULD SOMEONE WITH A RISK OF DIABETES LOOK FOR?
The following symptoms of diabetes are typical. However, some people with type 2 diabetes have symptoms so mild that they go unnoticed.
Common symptoms of diabetes:
- Urinating often
- Feeling very thirsty
- Feeling very hungry—even though you are eating
- Extreme fatigue
- Blurry vision
- Cuts/bruises that are slow to heal
- Weight loss—even though you are eating more (type 1)
- Tingling, pain, or numbness in the hands/feet (type 2)
Early detection and treatment of diabetes can decrease the risk of developing the complications of diabetes.
WHAT IS THE DIFFERENCE BETWEEN PRE-DIABETES AND DIABETES?
Before people develop type 2 diabetes, they almost always have prediabetes—blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. Prediabetes puts you at a higher risk for developing type 2 diabetes and cardiovascular disease.
There are no clear symptoms of prediabetes, so you may have it and not know it. You can find out if you’re at risk for prediabetes by taking the ADA’s one-minute risk test at diabetes.org/risktest.
WHAT CAN INDIVIDUALS DO TO REDUCE THEIR RISK OF DEVELOPING DIABETES?
You can’t change many of the risk factors—in particular, family history (genetics) and increasing age. The main thing people can control that affects their diabetes risk is keeping a healthy weight through healthy eating and physical activity.
Dr. McIver answers your questions on the next page.
Q: What’s the correlation between A1C and Blood Sugar numbers?
A: A1C represents and average of a person’s blood glucose levels over 2-3 months.
Q: Is it true that taking metformin causes dementia?
A: No. One study in Taiwan got a lot of attention that showed an increase in dementia among people taking metformin, but many more studies, including a large one in U.S. veterans, have shown that metformin lowers risk for dementia.
Q: What A1C level is pre-diabetic?
A: 5.7 to 6.4%
Q: Are spicy foods good for diabetes?
A: There is no direct relationship between spicy foods and diabetes. Healthy eating is important, and some people may find it appealing that foods that get their flavor from spiciness instead of lots of fats and salt.
Q: Is cinnamon good for diabetics?
A: It’s neither good or bad. Studies showing an impact of cinnamon on blood glucose were using massive doses with very modest effects. Normal amounts of cinnamon in the diet don’t have an effect.
Q: If a woman becomes diabetic while being pregnant does it stay with her the rest of our life?
A: Not necessarily, but having gestational diabetes does increase the risk for type 2 diabetes later in life.
Q: What is border line diabetics?
A: There is no such thing as “borderline diabetes.” Once diabetes is diagnosed, it’s important to treat it. Prediabetes is a condition that precedes type 2 diabetes, but it is not “borderline diabetes.”
Q: How can I manage non- diabetes hypoglycemia?
A: Hypoglycemia that’s not caused by certain diabetes medications is unrelated to diabetes (and is relatively rare). Some conditions that can cause hypoglycemia such as pancreatic tumors are very serious and should be diagnosed and treated by a doctor.
Q: Are natural sugars like in fruits and vegetables better for managing diabetes?
A: All sugars have the same effect on blood glucose levels. The sugars are not better, but consuming sugars in fruits that also come with the fiber and nutrients of fruit are healthier than refined sugar foods.
Q: Doctor why they don’t tell diabetics that the key to getting rid of it is animal products?
A: There’s no relationship between animal-derived foods (meat and dairy) and diabetes. There is a relationship between being overweight and developing type 2 diabetes, and foods that are high in calories, which includes high-fat meats and some dairy products (but not lean meats and low-fat dairy) can contribute to high-calorie meals and a greater risk of obesity.
Q: Doctor what about women who have diabetes going through menopause will it affect the diabetes?
A: Any changes in the body’s hormones, e.g. puberty and menopause, can affect the action of insulin in the body and the body’s metabolism. A menopausal woman with diabetes should work with her doctor to see whether any changes need to be made in her management of diabetes.
Dr. LaShawn McIver is Senior Vice President of Government Affairs, Advocacy & Community Integrated Health at the American Diabetes Association (ADA), the nation’s largest voluntary health organization leading the fight to end the diabetes epidemic.
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