I've gotten my second ramp-up dose of Tecvayli and everything is fine so far. My brain is complibikkprrr clear.
Blood sugar is the new hotness. Last time I was here no one cared about it. This time they're pricking my finger five or six times a day to keep track of it and getting excited if it's too high or too low. I'm not sure why they're suddenly so concerned when no one ever has been before. All that's happening is that my glucose level is shooting up temporarily after I take the dex, but they're getting excited anyway.
Did I ever show you my A1C after three years of weekly dex? No? Don't pretend you don't want to know.
I've taken dex off and on for the entire ten years of multiple myeloma, but there was a three-year period of constant dex when I was taking darzalex/pomalyst/empliciti, and toward the end of that period I asked for an A1C test. Shazam! 10.6. But then I stopped the dex in preparation for the CAR-T treatment and within a few months it was down to the low sixes. It's bounced around there ever since.
This has produced endless confusion about whether I "have diabetes." My latest score, for example, was 6.5, which just barely puts me in what's normally considered diabetic range. But for some reason, a few months ago the Kaiser computer decided the normal A1C range for me extended up to 7.4, so my score is OK. Sort of. Depending on who's looking at it.
And all the pre-meal finger-prick tests have been consistently around 105 after the dex wears off, which is just lovely. It's the equivalent of an A1C around 5.3.
So . . . I don't know. I guess I'm high enough that I should be careful about things, but not so high that I need to panic.
Pretty riveting stuff, eh?
I'm glad you don't have to keep taking the steroids, they are really hard on the body. Hgb A1C is highly derivative and doesn't always mean anything.
What’s riveting is you’re still with us. I don’t necessarily need to understand the jargon. The brat cats need you.
My confidence in the medical profession took a hit when my GP told me, 20 years ago, that my routine annual blood tests returned a glucose reading of 5.6 mmol/L, and consequently I had "pre-diabetes". He referred me to a clinic to take a fasting glucose test.
Fortunately this was the dawn of the internet age, so I was able to gather lots of information about diabetes. I was shocked to find that in Australia at that time, if a fasting glucose test produced a result of 11.1 mmol/L or higher, I would be diagnosed with diabetes. A reading of 11.0 and I'd be fine! This was such a self-evidently idiotic way to manage a major health problem that I didn't believe it at first. It was like saying a single blood pressure reading of 141/85 meant you suffered from hypertension, whereas 139/84 meant you were good to go.
I invested in a bunch of blood sugar test strips, tested myself regularly, and satisfied myself that I did not have a significant risk of developing diabetes. My regular annual test result today is the same as it was 20 years ago. And because of the revelation this episode provided about contemporary diagnostic methods, I now know that anyone who says (like Trump) "my blood pressure is 120/80" is making a childishly meaningless statement.
Having worn an ambulatory blood pressure monitor for 24 hours, I can confirm it varies enormously from minute to minute. Instead of evaluating my BP by letting my GP test it once every six months in her surgery, I have my own monitor and test it three times a day for seven days before my six-monthly check-up. Instead of being diagnosed as dangerously hypertensive on the basis of a single reading when I'm pissed off from having to wait 40 minutes past the time I made an appointment to see my GP, she and I now agree my BP is completely under control.
We laugh, legitimately, at "doing your own research". But when it comes to common medical conditions, doing your own research plus gathering your own data can be much more effective than trusting the findings of a harried GP in a 12 minute consultation.
It's the same way in the US, although I would say less the medical profession and more the way the average person interprets the information. Here, an A1C value of 5.7% is treated by many to be a magic threshold; stay below it and you're perfectly fine, cross it and you're doomed.
I have been “prediabetic” for about 12 years now. During this time my A1C has been remarkably stable, way below the levels all those people in the TV drug adds brag about reaching. I had a chat with my physician and we agreed as long as I remained prediabetic there was nothing to worry about. The whole “prediabetic” label is misleading.
Australian Dept of Health guidelines abandoned use of "pre-diabetic" as a diagnostic term some years ago. And many doctors now prefer the HbA1c test as a diagnostic tool instead of the old fasting glucose test.
By how much is one's blood glucose level expected to fluctuate when fasting prior to the test? Is it indeed expected to be as variable as blood pressure?
There are two different tests, which I didn't explain properly. The traditional test was a simple measure of blood sugar after overnight fasting. Any reading over (from memory) 8, and you were pronounced diabetic. My results using test strips varied from low 5s to low 6s, without linking to any variable I could identify.
The other test involved sitting around a lab doing nothing for hours, following which they'd hit you with a massive dose of glucose. If you hit 11.1 mmol/L or higher in a sample taken an hour afterwards, you were diabetic.
These days up-to-date doctors prefer the HbA1c test, which gives a measurement based on sugar content for recent months. It doesn't require any fasting.