I was trying to decide between several different topics for this week. One that is on my mind is a variation on “it takes a village” and the support that I’ve received since going public with my journey. Another is about my actual mechanical process for food, nutrition, tracking, etc. and appointments. Another wants to update on a bunch of miscellaneous things. But I jettisoned all of them because I have BREAKING NEWS.
On Monday of this week, I had my medical checkup and this was my 3-month benchmark since I had my original blood work done in September/October. I did the new blood work last Friday, and while they are checking lots of things to be safe, the big marker for the test is my A1C number.
For those not familiar with bloodwork and diabetes, the A1C measures “blood glucose levels”. Your red blood cells have hemoglobin proteins in them to transport oxygen around your body. Sugar / glucose can attach themselves to hemoglobin, and the specific type they attach to is hemoglobin A. When the two attach, it is called glycated hemoglobin (A1C). Some people have to monitor blood glucose levels every day by pricking their thumb at home, and it’s good for daily management, but the real BIG test is the A1C marker which has a lifespan of about 120 days. While your day to day stuff can fluctuate wildly, even within a single day or after a meal or workout, the A1C is basically treated as a 3-month average. So you do the bloodwork every three months to see how you’re doing. That’s an oversimplified explanation, but close enough.
Back in October, my number went to 7.1% i.e, 7.1% of my red blood cells were glycated. Below 5.5% is considered normal. 5.5 to 5.9 is “at risk” for diabetes, 6.0 to 6.4 is pre-diabetes, and 6.5 or higher is diabetes. There’s a bit of confusion out there about 6.5 or 7.0, and I don’t know if the number changed at some point or not, but some sites list diabetes as 7.0 or above, with a prediabetes as 6.5 to 7 and at risk from 5.5 to 6.5. Regardless, I’m going with the official Canadian Diabetes Association numbers, which are the under 5.5 / 5.5-5.9 / 6.0-6.4 / 6.5+ cutoffs.
My October numbers were the first ones I had done in two years, and I was now at 7.1. Previously I had only gone as high as 5.9, and while nobody ever explained the numbers, it was “hey you’re at risk” … but I had always been “at risk” anyway, with both being overweight and having a family history of diabetes. But since I hadn’t been tested in several years, and my weight increased in that time, I blew past the “at risk” cutoff (5.9) and the prediabetes cutoff (6.4) and into official diabetes territory. I commented previously that it didn’t really mean much to me, as it seemed almost incidental to my commitment to losing weight. It didn’t really change anything for me, other than triggering some extra meds.
But when I was blogging about non-scale indicators, my sister-in-law and others pointed out that the A1C number would be a good indicator. I confess I felt almost stupid … since I had dismissed the impact of the diagnosis, I hadn’t really paid much attention to the number either. But OF COURSE it would be a good non-scale indicator, duh!
So Friday was my test date. And I have my new A1C number. My previous was 7.1. My new one?
5.9, baby! Woot woot!
Oh, sure, I’m still in the “at risk” category, but I’ve basically put myself back to where I was 2.5 years ago. And since I have kept losing weight, all my various numbers are looking good.
For example, my untreated blood pressure once went as high as 160/110, which is stroke territory. At the time, I was maxing on decongestant, so maybe not a completely “fair” number, but without decongestant, I was still in the 140/100 range. With meds, I range from 115/85 to 130/98 or so.
Monday? My average at the office, which is often a bit higher than at home, was 111/75. Woot woot!
Which puts me in a different conversation about meds. I discussed them at some length with the doctor and then I also did a full check-up with one of the pharmacists at my regular pharmacy. My favorite pharmacist is in Peterborough of course, and my second favorite one is on vacation, so Hassan had to pinch-hit.
First up? My Metformin that I take to make my body process insulin better, and helps keep my A1C numbers under control. Some of the drop from 7.1 is from my weight loss, some from the diet changes, some from the medicine. They started me on a dose of 500 mg. I couldn’t tolerate it on my stomach, lots of cramps initially, so we cut it back to 250 mg with a plan to move to something called Jardiance. I finished my Metformin trial late last week and started the Jardiance on Saturday. One of the side effects of Jardiance is fatigue and apparently it can hit shortly after taking the medicine. Based on Saturday night and Sunday night, I wouldn’t want to be driving anywhere! Sure wiped me out fast.
However, since the Metformin was working, and even doing so at the low level of 250mg, we don’t need to actually switch me to Jardiance after all. So, I turned those pills back in, got a new Metformin prescription, and we set it at the lower dosage of 250 mg. It’s working, no need to increase is the logic. Interesting considering it is half the starting dose for most people, and some people even have to take 1500 mg a day. I’m happy with 250 mg.
For my blood pressure, I take two meds. Amlodipine and Hydrochlorothorazide. The Amlodipine is apparently not as effective as another drug, Ramipril, for those with diabetes, so we’re switching me over. Plus Amlodipine causes swelling of the ankles and calves which I have experienced. I will be happy to not have that, if it helps. I have to monitor though for the risk of the new medication taking my blood pressure TOO low, since at 111/75, I’m at the very low end of the med’s usage. When I lose another 25-30 pounds, we’ll need to revisit that amount…might have to reduce the dosage. I’m only at 5mg on the new one, so we’ve already reduced slightly. We’ll revisit the Hydrochlorothorazide in 3-6 months too but I might be able to get off that one completely and just use Ramipril for the future, and maybe even get rid of that one too eventually. Woot woot!
That leaves my Lansaprazole / Prevacid. I’d like to get off that too, but considering without it that my first “incident” had me thinking I was having a heart attack, I want to ensure the efficacy of whatever approach we take to weaning me on to something else. It might just be something like Tums or Gaviscon.
Although I confess that while I’m okay with doing that, I’m of two minds…first I need to be sure of the efficacy, but second that we are basically substituting a med that I have to pay for myself for one that is already covered. I can afford it, but I know there are lots of people out there who wouldn’t be too thrilled about shelling out extra cash for something each month if it is already “addressed” through their existing meds. I understand the health implications, and the reason to switch, I just find it a bit less obvious a decision than the medical professionals seem to think. None of them have asked at all about the cost implications to me. Again, fine for me, but what about others?
On the other hand, I just filled a prescription last week for two months of Jardiance but I only took it for two days and then gave it back for destruction. I’d like to think they would reuse the meds as they are in sealed individual blister packs, but I know they probably can’t. Meanwhile the benefit plan paid for them and I’m sure it’s not cheap.
Overall, I was at three meds before this started, and I’m up to four with a chance to be down to three in three months, two in six months, one in nine months, and maybe, maybe, maybe, none as of a year from now. Although, as my favorite pharmacist pointed out, I may still have one med to act as a protective / preventative med to make sure my body doesn’t get too worse at processing sugar. And so far at least, no injections. A friend was telling me about Trulicity working well for them, but so far, I don’t need it, everything I have is working well.
Woot woot! Even if the original diagnosis didn’t matter to me, I’ll take the 5.9 as an external indicator of progress.