When Progress Isn’t a Positive Thing

"Your A1C is up a bit," said the voice on the answering machine. "Watch what you eat."


Wow! Was that helpful or what?!

The voice belonged to a nurse in my husband’s primary care doctor’s office, and I can think of a few things she could have said instead:

“Your A1C is up a bit. Please call the office so we can set up an appointment for you with a dietitian.”

“Your A1C is up a bit. Perhaps we need to reevaluate your medications.”

“Your A1C is up a bit. Have you been sick or stressed lately?”

“Your A1C is up a bit. Can you increase your exercise some each day?”

I have some of my own such as: “Honey, I know you love pasta. Maybe you could eat it for breakfast instead of for a bedtime snack.” It would, at least, give him a chance to exercise the blood glucose levels down instead of sleeping on them.

Anyway, I think there are some problems with the message. First of all, what is his A1C (or HbA1c) up to, and from what? I pondered that, with the understanding that care does have to be taken when releasing private medical information. Then I decided that the fact he had an HbA1c was private in itself. After that, what would have been wrong with giving the numbers? And how much is “a bit,” anyway?

The message assumed that the problem was food-related. We all know that food isn’t the only culprit. Stress, illness, lack of physical activity, hormones, the amount of sleep you get, medicines taken (or not), the alignment of the planets and phase of the moon… One or any combination of those can raise havoc with your diabetes management.

Many doctors don’t understand the nuances of Type 2 diabetes and don’t seem to understand that it’s often a case of progressive beta cell destruction resulting in a need for changes in therapy. I recall being chastised for “noncompliance” when what I really needed was insulin.

Heck, many don’t seem to understand diabetes—either type—at all. They seem to believe high blood glucose levels are all food-related. Exercise is a given—it mostly reduces blood glucose levels. As for nuances, ask any woman about the effect of her monthly cycle on blood glucose levels and you’ll realize there’s more to it than food!

My husband was diagnosed with Type 2 diabetes several years ago. He has yet to be referred to a dietitian or to a diabetes educator. Yeah, yeah, I know: He lives with me. Like he listens!

Instead, like many of us, he makes excuses for why his HbA1c level is high: It was just after the holidays. He wasn’t fasting when the blood was drawn. He’d eaten pasta the night before (like that’s unusual!). Yada, yada, yada.

The cold, hard facts are that, in the beginning, he was able to manage his diabetes doing what he was doing in terms of food, physical activity, and the like. Now he can’t. The diabetes, as Type 2 is known to do and as I’m not sure many doctors understand, is progressing. Changes need to be made—in drugs, in food, in exercise, in all three.

I think it’s time I sit him down and have a little—no, make that a major—talk with him. I kind of like him and would like to keep him around.

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  • GeraldN

    I’ve worked as a geologist for 45 years but started posting less than 48 hours ago. On 2 sites, I described what worked for me. I was then barred because I was told not to “promote” or to “advertise” what worked for me, I even sent my CV but that did not help. In any event, I have taken a safe supplement that apparently works by blocking an ion channel. This would be Kv1.3+ in the Double Negative Natural Killer T-Lymphocytes that inflame the pancreas and inhibit insulin production. I am hesitant to name what worked for me but am generally curious since I’m new to posting, is it a no-no at diabetes sites to clearly say what made me symptom free? I ask because I have been told not to name the product at 2 other sites. Please inform. I figure there’s lots of hype out there. Then again, when I find gold, I want to share it. I suffered for years from diabetes. I am presently symptom fee although I am technically a Type II diabetic right now.

  • Barbara

    This article points out facts that are so true but seldom even mentioned. The doctor and his nurse always tell my husband to watch his diet when his blood glucose levels are elevated. Sometimes such elevation happens even when there has been no change in diet, or perhaps, he has been doing even better than usual. I know that his two big factors are stress and lack of exercise… I can almost predict when the glucose levels will shoot up.

    Also, I feel diabetics should have a “refresher course” with a dietician at least once a year. So much is forgotten between times. The diabetics spouse should also be included in such sessions.

  • Carmen

    Far too often people with Diabetes, carry this little thing called “guilt” along with them. We feel guilty when going for that second cookie, when we forget to test, etc. How many times have our parents and medical staff told us to “Make sure we are taking care of ourselves…because you know Carmen, the real reason why you have a high A1C is because 1) you don’t test, 2) you don’t eat properly and 3) you probably aren’t giving your insulin regularly” However, folks that don’t have Diabetes don’t realize that even Diabetics get thrown curve balls, just like Jan’s husband. What baffles me is his nurse just assumes that his A1C is up because he is eating too much. Nice going nurse. The numbers could be up for a variety of reasons, just as Jan mentioned. Say if this nurse left the same message for the young 16 yr old girl who is struggling with body image issues? I could just imagine how the guilt would leave her feeling…and doing.

  • Tara Dairman, Web Editor


    You may want to discuss the supplement you take over at Nurse David Spero’s recent blog entry, “Do You CAM?” which is about complementary and alternative treatments for diabetes.

  • Rebecca

    I am new to this website and blogs. Was just diagnosed w/ Type 2 in late Oct. and got a chuckle out of the comments above about the medical staff’s lack of knowledge about diabetes and managing it. I am a nurse who works in research [lots of diabetes research] and thought I knew all the basics of diabetes from years of clinical nursing and research. But am finding as a diabetic managing my own care, I want/need to understand more as well as the complexities of diabetes. Seeking more brought me to this website for which I am grateful. Body chemistry most certainly has alot to do with A1C, glucose levels, foods and meds. I have a whole different perspective now than I did 3-4 months ago.

  • Cathy W

    I am not a diabetic but I did take care of one for 6 mo in my home I did the food and made sure the meds were taken and her A1c test went from 15.2 down to 6.2 in 6 mo. and had some raised glucose readings but all in all was on a good diet. She also lost 50 pounds. She was now down to 210 pounds. Then she moved back home and in 6 wks she gained 38 pounds and her A1c is up. I think she as with alot of people don’t really see all they are doing and want to blame other things and not that they are not really paying that close of attention to what they are eating and how much. She has been a diabetic for 15+ yrs and claims she couldn’t do it. But yet she did when she had no other choice! She really did well! We counted Carbs and measured portions and eat healthy like everyone should eat not just a diabetic anyone should eat like this!! It isn’t that bad! You feel better and will live longer and healthier the years you are here!