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Diabetes Testing

The Numbers That Drive Our Diabetes Management

Dr. Tim Reid asked me a couple of days ago why I was so numbers driven. I had just spoken at a meeting of diabetes professionals about my success in bringing my weight between February 2006 and May 2008 from 312 pounds, which is a body mass index of 39.5, to 156 pounds, a BMI of 19.8. Today after a nine-hour hike in the mountains yesterday it is even a little lower, 154 pounds, a BMI of 19.5.

Dr. Reid  treats patients at the Mercy Diabetes Center in Janesville, Wisconsin. He also serves as the chairman of the Department of Family Practice for Mercy Health System.

At the meeting I had also told him and the other members of the group how I brought down my A1C level from 14.4 when a doctor first told me in February 1994 that I have type 2 diabetes. Now it is 5.1.

But I fumbled at answering Dr. Reid’s question. Admitting that I am not an engineer with the engineering mentality that delights in numbers, when he asked me why these numbers were so important to me, I didn’t have an answer on the tip of my tongue.

I do now.

When we don’t have specific goals we aren’t able to control our diabetes and our weight without them controlling us. The key is to be as specific as we can.

To have a good chance at being successful in reaching our goals we have to go beyond acknowledging them to ourselves. We have to publicize them.

That means we have to start by stating them in concrete terms. When our goals are weight loss, we need to express them in terms of the body mass index that we are aiming to reach.

The body mass index is a simple tool that relates our weight to our height. It applies equally to men and to women. It’s not perfect, since it doesn’t work for children, weightlifters and other heavily muscled types (because muscle weighs more than fat), and pregnant women. I especially like the U.S. government’s standard and easy-to-use calculator because it recognizes fractions of an inch in height and tenths of pounds in weight. We can easily find it online at http://www.nhlbisupport.com/bmi/

For Checking Our BMI Level

If we would instead express our goals as pounds lost, we would give up something important. We would find it easier to lose track of our goal. For example, I know one man who is famous for losing 180 pounds. That’s great, but he started from a weight of 410 pounds, and when I met him, his BMI was obviously above a normal level.

We need to set our weight loss goal at a normal weight, which is a BMI of 18.5 to 24.9. In acknowledging it, we need to go beyond making a mental note of it. We need to write it down. Better yet would be to track it on a daily basis, which I do in a file on my computer.

Just as important, we need to publicize it. We need to tell our family and friends what our BMI goal is and what it currently is as we progress toward our goal. Talk to them and write them too. We are essentially promising our friends, and friends don’t break promises to friends.

Of course we can change our goals. I set my BMI goal originally at 24.9, barely in the normal range but also conveniently at the weight my discharge papers from the U.S. Army said I had half a century earlier. After reaching that goal, I decided that I would be healthier and feel better if my BMI were 19.5. When I reached my revised goal, I made sure to tell people about it — not to brag but instead to keep the pressure on me not to exceed that weight.

Since we calculate our BMI by comparing our height and our weight, we need to be specific in determining these measurements. Our height is our current height in the morning.

It’s not how tall we were when we were 20 or 30. All of us shrink at least a bit as we get older. The only exception that I know of is Rolfing therapy. I know that got back an inch of my height after I completed the standard 10 sessions.

We also shrink during the day, unless we are true couch potatoes and lie down all the time. How tall we are in the morning is a fair measure of our current height, especially because that’s the time to weigh ourselves.

I make sure to weigh myself every morning when I am home and can use my bathroom scale. I wrote about the reasons to weight daily in my recent article here, “A New Way for People with Diabetes to Lose Weight.”

The scale that we use needs, of course, to be accurate. It also has to be a digital scale, not one of those old-fashioned analog types where we can too easily “interpret” our weight.

Our weight has a lot to do with our A1C level. At a normal weight we are able to maintain a normal A1C a lot easier.

For Testing Our A1C Level

In my article here three years ago, “The Normal A1C Level,” I reviewed the relevant research. My conclusion was that a normal level is much lower than the goals that the American Diabetes Association and other medical organizations would have us set.

No one knows for sure the level that active, healthy, 20-year-olds typically have, but it is probably closer to 4.2-4.6, the level that Dr. Richard K. Bernstein sets for himself and his patients, as I wrote in the article that I link above, than to the maximum of 6.0 that one study shows that typical Americans have. That’s because typical Americans typically are overweight — 66 percent of all Americans have a BMI of 25 or more — which must have at least some effect on their A1C levels.

I make sure to keep my A1C level as low as possible, because I know that the chance of diabetes complications increases at any level above normal, and in fact increases exponentially as our blood glucose goes higher.

While I have reached my weight goal, my A1C goal is still a work in progress. I write about it now both to put a little pressure on myself to do a little better by publicizing it and hopefully to inspire you to set an A1C goal in the normal range.

Again, we need to be specific about the numbers. Not all A1C tests are created equal.

The standard recommendation is that “The test should be performed in a laboratory using a method that is National Glycohemoglobin Standardization Program (NGSP)-certified and standardized to the Diabetes Control and Complications Trial (DCCT) assay.” This is according to the American Diabetes Association’s “Standards of Medical Care in Diabetes — 2011.” In practice this means that the A1C test we use needs to be one of those on the “List of NGSP Certified Laboratories.”

Not every A1C test performed in a doctor’s office or in a hospital is on that list. But at least one home test is, the Bayer A1CNOW+. This is the test that I use to determine my A1C level.

These are the numbers that drive my quest for great health, something available even to those of us who have diabetes. My A1C and my BMI are the two numbers engraved on my mind.

This article is based on an earlier version of my article published by HealthCentral.

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  • Maria Guerra Overton at

    It was refreshing found, but pure accident, this page,.I will be visiting it and asking questions,. I am a Spaniard living in Canada, I lived in the saxon culture for a while now.
    I am diabetic since I was three, and found so difficult to get answers to my questions that it is very depressing.
    I was in the called, “humain insulin: for five years, due to which I lost most of my eyesight and was left with some type of seizures. One y ear ago changed to porcine insulin,which really kep my sugar levels even, and low. However, other problems appeared. I want answers to , what to me , appear to be very simple and basic questions.
    I Do not know that it is because nobody has the answer .That is very hard for me to believe.
    or, because they believe I do not deserve such answer,that I over stepping my rights to ask. etc.etc.
    I am suffering of some type of gatric problems. and
    a)do the pork insulin sensitivize you to a numebr of foods?
    C)Is there a supresion of C23 peptide in commercial pork insulin?
    d)is such supression causing in patients some gastrointestinal side effects.
    I have been a patient over three continents AND several countries.I am a researcher, but I am a patient, I would like to know before I am more or less pushed to return to a medication which scares me so much
    i am sorry for being so inquisitive.I AM A SPANIARD!tHAT IS MY EXCUSE

    • David Mendosa at

      Dear Maria,

      I am posting your comment because I don’t know how to answer you and hope that someone else does.



  • katiebird at

    How often do you test your A1C level?

    • David Mendosa at

      Dear Katiebird,

      Thanks for asking. I test much more often than the standard recommendation, which is, as I remember, about every six months. I usually test every two months. Since I use the home test call A1CNow Self-Check, which we can get at any drugstore, I don’t have to go to the trouble of a doctor’s appointment and lab test for it.