David Mendosa's Article on Normal A1C Levels

David Mendosa (a favorite writing peer and type 2 diabetic) recently researched and wrote an article on “normal” A1C levels.  I don't entirely agree with his summation, nor do some others who responded to his article. 

One diabetes doc, Dr Helen Hilts, spoke of the increased risk of heart disease with A1Cs that creep up to the 6.0 point (lower than the ADA recommendations).  Her A1C is 4.6.  Dr. Hilts writes:  “High insulin levels  cause heart disease in 9 ways:  increasing inflammation, free radicals, and oxidant levels in the body; by raising blood pressure, triglycerides, total and LDL cholesterol, and lowering our good cholesterol (HDL); and by increasing our clotting in the bloodstream.”

In fact, since he was refuting Dr. Bernstein’s assertions but did not contact him for clarification, the doc spoke up as well.  Here is Dr. B’s response to David:

 “Hi David

If you had contacted me with a draft of your A1c article I would have shown you the flaw.

See DIABETES CARE :  Vol 25 pp 275-278 feb 2002 for an accurate formula converting A1C to avg BG.

It's also in my book and gives an avg BG of 136 for an A1c of 6%. An A1c of 4.7 would give an average BG of 90mg/dl.  It seems to me that BGs of the US population are running too high and are PATHOLOGIC  Not NORMAL. Average does not mean normal. Just look at body weight, metabolic syndrome etc.

I'd be glad to discuss with you the problems associated with the new conversion formulas from A1c to average BG performed by David Nathan’s ADA group.

Dick

PS – Note that A1cs in my book are based on avg BGs of young adults in the 1980s when people were healthier. I pointed out that we are all entitled to those BGs and they are attainable if you don’t have gastrparesis and untreated CHO craving.”

RICHARD K BERNSTEIN, MD, FACE, FACN, FCCWS

Here’s my response to the article:

Hi David,

I am also very fond of Dr. Bernstein and the information he has provided diabetics that just plain was not readily available without him.  I am also enormously grateful to him for his work on glucose monitors since they ADA wasn't interested. 

I am a juvenile onset diabetic of more than 32 years.  Prior to reading Dr. Bernstein's book and other material, I maintained the recommended target of <7 and 110-140.  I have no major complications but plenty of "features" I can do without.  Several have abated or reversed themselves since I started targeting an average blood sugar of 85 and having consistent A1Cs of 5.1

Though I haven't yet broken the 5.0 barrier I still strive to do so.  I eat far fewer carbs than recommended though not as few as Dr. Bernstein.  However, when I have cut back that far, my deviances have been far fewer - including lows.  I attribute that to less insulin, less russian roulette.

I do have a board buddy with several more years of experience than I.  He eats more protein and fewer carbs than even I do.  He also hung for years in the 5.2/5.3 range until a few years ago when he started taking a statin.  He has since been in Dr. Bernstein's range. 

I attribute my deviations to several things 1) Female hormones; avoid them if possible 2) Cortisol - I don't sleep well and have varying amounts of dawn phenomenon 3) Stress - THAT I have a master's degree in and it is usually accompanied by adrenalin bursts which result in short periods of insulin resistance 4) medications that also cause periods of insulin resistance (minimally, thyroid and birth control medications) 5) Incorrectly "guessing" digestion of food which tends to result in moderate lows (40-60) and the eventual digestion of the food and extra insulin to "fix"/"cover."

When I look at all the challenges I put my body through, I suppose I'm very fortunate for attaining 5.1s so consistently.  However, I will continue to work to get < the magic 5.0.  I know how much better I feel at 5.1 than I did in the mid 6's. I can only imagine how good 4.2-4.6 could feel.

Doris J. Dickson