If you’re living with type 2 diabetes, regular A1c testing is the norm for you. When you go to take these tests, it’s also an opportunity to speak with your primary caregiver about your condition — especially if you have difficulty managing this condition. It may be that your A1c was previously well-managed with lifestyle and treatment changes, but lately your numbers tend to fluctuate.
If your A1c levels are too high and won’t move into the safety zone no matter what you do, your doctor can help get you on track.
On average, a person only has 13 minutes with their doctor each visit, so it’s important to be prepared. By asking the right questions, you can maximize the value of the appointment. Here are some suggestions on what to ask your doctor if you’re living with type 2 diabetes and your A1c levels are stuck.
1. Are there other medications available that can help control my diabetes better?
Our needs change as we get older. The same is likely true when it comes to the way you manage type 2 diabetes. Lifestyle changes, stress, and even aging itself can affect how you treat your condition. While you may have previously had success with insulin or oral medications, it’s worth checking in with your doctor to see if other medications may be a better fit given your current needs.
There are a number of newer therapies on the market to help control glucose levels in people with diabetes, and even more on the horizon. Doctors and scientists are working to devise new treatments that will better manage — or even cure — type 2 diabetes.
2. Could something be making my A1c test results inaccurate?
Hemoglobin A1c has pretty much been the gold standard for monitoring glycemic control since its inception in the 1970s. The American Diabetes Association added A1c as a criterion for diagnosing diabetes in 2010, locking it in as the primary indicator of glucose levels in people with diabetes.
That said, sometimes the A1c test can give false or misleading results. An extremely elevated level of triglycerides, bilirubin (a byproduct of red blood cells), or uremia (waste products usually filtered out by the kidneys) in the blood can cause a false A1c elevation.
Low turnover of red blood cells, which occurs in those who have iron, vitamin B-12, or folate deficiencies, can also cause falsely elevated readings. High turnover of red blood cells, as occurs in those with sickle cell anemia, can result in falsely low readings.
Other causes of false increases or decreases include pregnancy, overingestion of certain vitamins and supplements, and lead poisoning. This helpful chart outlines known causes and their effects. If any of these apply to you, tell your doctor at your next visit.
3. Is there an alternative to using A1c for measuring glycemic control?
While A1c has many advantages for long-term glucose monitoring, it’s worth considering an alternative test if your levels remain inconsistent with your lifestyle choices. These tests can measure:
- fructosamine (also called glycated serum protein)
- glycated albumin
- continuous glucose monitoring
The journal Nephrology Dialysis Transplantation offers a more in-depth explanation of each test and how it can be used with the A1c test.
4. Are you accounting for my ethnicity?
It’s a fact that glucose levels vary between the black, white, and Hispanic populations. For many years, it was assumed that this difference was mostly due to levels of adherence and access to care among each population. But a recent study finds that those factors account for a small percentage of the difference — only about 14 percent.
While your doctor is likely aware of the ethnicity factor, it doesn’t hurt to ask. Never assume that your doctor knows more than you do.
5. What is empowerment therapy, and how can I use it to improve my diabetes self-management?
Self-care may be the most challenging part of diabetes management. It’s also the most important. It can often feel like the “real world” isn’t conducive to maintaining a healthy lifestyle. Sometimes it’s hard to stay on track or know what you should be doing.
With the popularity of measuring treatment outcomes to determine success, healthcare providers are turning to empowerment therapies like the Conversion Map, an interactive tool for managing diabetes. According to the Journal of Diabetes Research, the goal of such tools is to help people connect the dots between general advice and their personal goals and management plans. And it’s working.
A recent study commissioned by the American Diabetes Association offers a great example. It monitored people who used conversation maps to understand their roles in diabetes self-management and goal-setting better. Before using the tool, 15 percent of study participants said they knew how to manage their diabetes. After the study, 75 percent felt they did.
Controlling your glucose levels is vitally important to good health for people with diabetes. If yours are stuck, don’t give up. Engage your doctor in digging deeper to find a solution. You may have to be patient while working through your options, but the payoff will be well worth the effort.