About Diabetes Numbers
Dear Dr. Roach: In a December column, you mentioned that the A1c result of 6.5 and above indicates a diabetic condition. My doctor is telling me that 5.6 is the cutoff, and since I’m at 5.8, I’m a diabetic. Does the goal change with age? I’m a 66-year-old male in very good health. Could you please clear up the conflicting goal? — M.C.
Answer: Diabetes, a decrease in the ability to properly metabolize sugar, has a wide range of severity. One measure of overall blood sugar is the A1c test, a measure of how much sugar is on the hemoglobin molecule. Sugar attaches to many proteins over time, and the A1c, also called glycosylated hemoglobin, is a standard measure of average blood sugar in the past few months, and so provides a better estimate of blood sugar than a blood glucose level, which is a snapshot of a particular point.
No matter the age, a normal A1c level is less than 5.7 percent, according to the most recent American Diabetic Association guidelines. Since yours is above that, your blood sugar is not normal, which I think is what your doctor is saying. However, the diagnosis of diabetes comes at 6.5 percent or higher. You are in between normal and diabetes, a condition called prediabetes, or sometimes impaired glucose tolerance. You are at risk for developing diabetes.
Fortunately, diabetes clearly can be prevented by a healthy lifestyle. In fact, in the definitive study, diet and exercise were proven superior to medication for preventing the onset of diabetes in people at risk. Decreasing sugar and starch intake and adding regular exercise are the keys to preventing diabetes. Much, much more information is available at www.diabetes.org and other websites.
Dear Dr. Roach: My husband’s dermatologist detected a swollen lymph node in his neck and referred him to a general surgeon. What is your opinion about immediately getting a surgeon’s advice, versus a second opinion from an ENT specialist or a gland specialist, or even from his personal physician? — R.P.
Answer: Enlarged lymph nodes are very common and have many, many possible causes. Infection probably is the most common, but patients and physicians are most worried about the possibility of cancer. Fortunately, only about 1 percent of people who come to the doctor for a concern of an enlarged lymph node have cancer, but it is wise to be cautious.
In most cases, a biopsy is not recommended unless the lymph node has been enlarged for more than four to six weeks. However, there are some characteristics of the node that might be making his dermatologist concerned. For example, a rock-hard node is more suspicious for cancer, as is the position of a node above the clavicle (collar bone). Also, the older someone is, the more likely it is to be cancer.
On the one hand, you don’t want to go through an unnecessary biopsy; on the other, you don’t want to delay if there is a high suspicion. Both general surgeons and ENT surgeons are likely to have experience with these and can advise you. Better yet, if you can see his personal physician without delaying the surgery appointment, that would be best.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.