It was a slow day in the emergency department. I was sitting across the bedside from my patient who came in for a left forearm infection check up. She was a 73 year old female with a history of diabetes. She was elegant and soft spoken. Prior to examining her wound which has been worsening, I asked her what her A1c number is. She wondered what an A1c number was and I explained that it’s a lab test wherein your doctor evaluates how well your diabetes is controlled. She was still puzzled and told me that she has been diabetic for 40 years and she haven’t heard about that term yet.
I paused for a minute and realized that if my patient has been diabetic for over 43 years and has no clue what Hemoglobin A1c is, there are probably thousands of patients who are in similar situation. That’s when I had an epiphany of some sort, tons of the terms that we use when speaking with the patients make no sense to them since they are medical jargons. We learn all these things in medical school but no one really teaches us on how to relay them on layman’s terms. It is imperative that we educate our patients in ways that they can relate to so that their knowledge regarding their medical conditions are accurate and they have a clear concept regarding their health status.
I decided to explain what hemoglobin A1c test is, in an easy way for her to remember. I explained to her that there are two types of diabetes. I proceeded to say, “Imagine that the inside of your body are like pipes which are interconnected. Whenever sugar or water goes inside, it reaches the organs, brain, heart and kidneys in your body since there are pipes all over. Normally after eating, your body has all these sugar floating around and the way to get the sugar out of your system is to convert it into energy. But before being able to turn sugar into energy, your organs need a key to unlock its doors, that key is called insulin. When you are diabetic, you have too much sugar floating inside your pipes and there’s no insulin to open the doors for your organs to use those excess sugars in form of energy. Patients whose bodies do not make insulin at all are called type 1 diabetics. We provide insulin for those people since their bodies don’t make it. Some patients have bodies capable of producing insulin. Unfortunately, the insulin produced which serves as a key does not fit the doors of their organs properly, that’s why the sugar can’t be used up. These people are type 2 diabetics.
After that, I explained, “you see, inside your pipes are small donut-shaped called red blood cells, which are like UPS trucks that run around and supply your body with oxygen.” This is the air you breathe in and they collect the remnant, carbon dioxide, which is the air your breath out. If you have a high blood sugar level, the sugar start sticking to these cells, making them look like small sugar crumbs from dunkin doughnut. The more sugar crumbs attached to your UPS truck, the worse your diabetes is. The red blood cells or our bodies’ UPS trucks have a lifespan of 120 days. After that, the truck dies and we can detect how many sugar crumbs are stuck on your trucks.” The percentage of sugar crumbs on your dead UPS truck is your hemoglobin A1c.
Your A1c is used to evaluate how high blood sugar levels and how well your diabetes is controlled. It can determine if you are trying to compensate a day before the test, in order for it to turn well. Let’s say, you have been bad and ate all the sweets you want, then the day before your next doctor’s appointment, tried to eat well and use insulin to keep your sugar under control. Your doctor asks how your sugar levels are, you confidently answer that it has been good and that you have been strictly monitoring your diet. The doctor then will send you this test then if the test comes back and the result is greater than 6.5%, you and your doctor will then both know that your diabetes is not well controlled. So always make it a point to watch what you eat.
She was very grateful on my explanation and even asked if the A1c number is the number that she sees on TV commercials with people who are holding a sign with numbers on them and smiling. I also smiled and said yes. She told me that on the following week, she will ask her doctor regarding her A1c levels and thanked me for the final time.
Next time your patient asks you about A1c, tell them this story and I’m sure that they will never forget it.
Adeleke Adesina, DO
Emergency medicine physician
Houston Methodist Hospital