Monitoring of Haemoglobin in Canadian Health Care Mall

HAEMOGLOBIN

I have had diabetes for ten years and now take insulin. I have been attending the clinic regularly every three months and do regular blood glucose tests at home with my own meter. At my last clinic visit, the doctor I saw said that he did not need to see me again for a whole year because my HbA1c was consistently normal – why did he do this?

It sounds as though your doctor has great confidence in your ability to control your diabetes. As long as you can keep it this way, he clearly feels that seeing you once a year is sufficient. He can then spend more time with other people who are not as successful as you are. On the other hand, if you find the clinic visits helpful and motivating, it may be disappointing to be left ‘on your own’ for so long. You could see your practice nurse, who may be able to provide the support you need.

I am treated only by diet. I find it very difficult to stick to my diet or do the tests between the clinic visits but I am always very strict for the few days before I am seen at the clinic and my blood glucose test is usually normal. At my last clinic visit my blood glucose was 5 mmol/L but the doctor said he was very unhappy about my control because the HbA1c was too high at 10% – what did he mean?

Your experience demonstrates the usefulness of HbA1c testing, because you have been misleading yourself as well as your medical advisers about your ability to cope with your diabetes. The HbA1c has brought this to light. Because the HbA1c reflects your average blood glucose over the previous two to three months, your last-minute attempts to get your diabetes under control before your clinic visit were enough to bring the blood glucose down but the HbA1c remained high.

My recent HbA1c was said to be low at 6%. Blood glucose readings look all right, on average about 5 mmol/litre. The specialist asked me to set the alarm clock and check them at 3 a.m. – why is this?

A low HbA1c suggests that at some stage your blood glucose levels are running unduly low. If you are not having hypoglycaemic attacks during the day, then it is possible that they are occurring at night and you are sleeping through them. By doing 3 a.m. blood glucose tests you should be able to determine whether this is so. Incidentally, you will only have to do these middle-of-the-night tests until you have established whether or not you are having hypos at night – they are not going to be a permanent part of your routine!

My diabetes is treated with diet and gliclazide tablets. By strict dieting I have lost weight down to slightly below my target figure. I am told that my HbA1c test is still too high at 9% and does not seem to befalling despite the fact that I am still losing weight. I could not tolerate metformin and am very strict over what I eat. At the last clinic visit the doctor said that I am going to have to go onto insulin injections. I have been dreading this – is he right?

It is normal to dislike the idea of starting insulin injections but it sounds as if your diabetes is out of control and this is the reason for your weight loss. Since you cannot tolerate metformin, the only treatment available would be a glitazone. There is a 50% chance that this would bring your HbA1c below the target of 7.5%. If this fails to help, the only option would be insulin. Naturally you are anxious about this but the chances are that you will find the injections easier than you fear. Most people do very well once they get used to the idea and feel much better once their blood sugars are lower.