[Diabetes-talk] HBA1C calculators.
Michael Park
pageforpage at gmail.com
Thu Apr 5 19:35:47 UTC 2012
Hi there.
I have been rather busy and have not had an opportunity to reply to the
thread until now. However, before launching into my reply, I have put
an Excel template which I will discuss in a bit more detail in the
course of this reply at
http://dl.dropbox.com/u/57438098/bs%20template.xlt
I want to first of all deal with the justification for an HBA1C
calculator. Let me say at the outset, that no matter how good the
calculator is, it can never substitute for the doctor himself. However,
the value of such a tool lies in the fact that you are less likely to
arrive at the doctor's rooms fearing the worst concerning your HBA1C
results, or worse still, if you are one of those diabetics who has it
firmly implanted in their minds that they have to please the doctor,
come what may, your HBA1C result will not come to you as a nasty
surprise. At worst, you can get out of the appointment for some reason
which you may think adequate and postpone the evil day.
More seriously, though, HBA1C is like cholesterol testing in this
country. There are two options for a person who has a cholesterol
problem and who wants to know how he/she is progressing in dealing with
the problem. You can either go to a pharmacy and have your finger
pricked for a mere $3, or you could fork up a $50 (excluding the
charges levied by the lab) to go and see a doctor about the matter.
The obvious advantage of the pharmacy route is obviously that it is
cheaper than going to the doctor and if a person does not have medical
cover of any sort, this is a better option.
However, the drawback of testing at a pharmacy is that when they prick
your finger and when you have waited the 5 minutes to receive your
result from the nursing sister on duty, you are only told that your
cholesterol reads whatever the figure may be, and that is the end of
the matter.
If, however, you go to the doctor and are referred to the lab, the test
which is generated, shows all manner of different results. I think that
there are something like 12 indicators in a full cholesterol test, but
I stand subject to correction.
The value of the finger prick test is that if you do have a cholesterol
problem, the finger prick test, with its limited information, will at
least alert you to the fact that you do have a cholesterol problem and
you can then go to the doctor and be tested so that the doctor can get
a full picture of what is boiling before prescribing Lipetol or
Simvotin or whatever. The bottomline is that while the pharmacist's
cholesterol test may not be accurate, it is likely to give you at least
enough information for you to be able to know whether or not you have a
problem.
The HBA1C calculator performs the same function IMPO, and places a
valuable tool in the hands of the patient. That tool should have been
in the hands of the patient long ago, but thankfully, the problem in
this regard is now solved.
As an aside, I am of the personal view that the best person to treat
diabetes is the patient himself--not the doctor, even though he may for
sake of argument, be the best in his field in the world. The doctor
merely has the knowledge to medicate and medication, in order to be
applied correctly, depends on information which lies beyond the reach
of the doctor and which ought to be within the patient's peculiar
knowledge. I am not decrying the medical profession at all, but I come
across this mentality of "the doctor will sort out the problem" from
too many diabetics I have counselled, which makes me want to grab just
anything and chuck it at each individual who comes out with that
garbage. The patient and the doctor are in a partnership relationship
in dealing with the problem, and each brings the information that
he/she has, to the table and responsible decisions are then made. The
patient, as it were, is the senior partner and the captain of the ship,
so to speak, and by that statement hangs an aweful lot that I would
imagine, you should be able to guess easily.
If the patient is put into a position of being able to identify
problems before going to the doctor, the consultation process is a lot
easier, more efficient and there is a strong likelihood that the
patient will go away from the consultation happy: knowing that the
cause of concern has been dealt with efficaciously.
The doctor on the otherhand, might decide on the strength of what the
patient has told him, to do an HBA1C anyway, which effectively renders
the whole debate about HBA!C calculators an academic exercise, since,
if the calculator is used properly: and the correct information is
entered, the doctor will be able to confirm for himself whether or not
there is a genuine problem. In this sense, therefore, the HBA1C
calculator acts like the finger prick cholesterol test at the pharmacy,
the only difference between the two instances being that you pay for
the finger prick, but the HBA1C calculator is mahala. The HBA1C
calculator can never substitute for the real thing, but it has this one
advantage: it keeps the doctor on his toes, since there are instances
and I won't dwell on them here, where patients do see doctors the world
over, and the HBA1C test which should be done twice a year at the very
minimum, is not done at all. For those who do not perform the test for
their patients, it is therefore a timely reminder to do so.
People eroneously think that the periodic visit to the doctor on
account of diabetes is just nother check up. The truth of the matter is
that inasmuch as one would not normally visit a doctor without reason,
generally, the same also holds true for diabetics. Sure, the check-up
is important, but primarily, this is the patient's opportunity to raise
questions and to ask about things that may be a bother or a potential
hazzard in his management.
In concluding this point, I want to give just one instance of
information that would lie within the particular knowledge of the
patient and to which one cannot reasonably expect the doctor to be
privy.
Let's say that the patient's HBA.C returns a result of 8 which is
clearly not an acceptable result. All that the doctor has in front of
him when he looks at the result, is the fact that the patient's HBA1C
is 8 and nothing else. He does not, purely on the strength of that
result, automatically have insight into the patient's lifestyle.
The patient may genuinely have problems with his/her sugar readings
which he/she would, as a responsible person, communicate to the doctor,
or the patient has simply not been looking after themselves. If the
latter is true, it is up to the patient to exercise the simplest of
choices: comply or face the consequences. There are no gray areas here,
not even by the wildest stretch of the imagination.
If the reason for the high reading is just a sugar problem and the
patient also communicates that fact to the doctor, then the problem can
be dealt with appropriately and the situation can, using the doctor's
experience and expertise, be medicated correctly. A doctor who
medicates without the information which lies peculiarly within the
patient's knowledge, at best, is playing a game of Russian Roulette,
and at worst, is downright unprofessional. This statement is also
subject, to a varying degree, to the patient's co-operation.
It is also for this reason that I am a strong advocate for the argument
that a diabetic's care should ultimately not lie with the general
practitioner, but with a specialist diabetologist and I spend my time
fighting with diabetics whom I counsel, and who have adequate medical
insurance and can afford the cost of seeing a diabetologist, about this
matter. The GP generally, and there are only a few exceptions in this
country at least, is just not equipped to deal with diabetics properly.
However, the general practitioner,the ophthalmologist, the
cardiologist, the biocheneticist, the general practitioner and the
diabetic nurse care-giver each have their part to play in the
procedure, but the diabetologist is, as it were, the chief of logistics
and the patient the chief of operations.
Now to the spreadsheet template and the calculator, but I must first
point out that my spreadsheet is different from the template in that it
gives me more information about the template. For one, our measuring
unit is MMol/L whereas the measuring unit in the United States is
MG/DL. Unfortunately, I am too senile to be able to do the calculation
to effect the conversion myself. So, I have included formulae in my
spreadsheet which will perform those calculations for me. These
formulae are not in the template, but then the template has been
designed in such a way as to enable readings of any measurement unit to
be entered, provided of course, that you stick to the one unit only.
I have taken the point that averages for certain times of the day need
to be included in a record of this kind and when I am a little bit less
under the whip, I will design a template accordingly. The template that
I have put out there, I must admit, assumes my personal circumstances.
The headings on the template speak for themselves and I am not going to
dwell on that topic. It would suffice for me to add that in respect of
the 7 readings average, you will only have an accurate average on or
after the 7th reading. For 14 readings, it will be on or after the
14th, etc.
The issue that needs consideration is this: what data should I enter
into the calculator, given the fact that I want to have a result which
will be as close as possible to the actual HBA1C.
There are two ways of doing this, the first being the lazy method and
the second being what I can best describe as the Master Average method.
The latter is likely to give you a more accurate picture as will be
seen from my explanation.
The lazy method is simple. Just take your 180 readings' average as it
stands at the present and enter that value into the edit field on the
calculator. In my case, of course, I also have to do a conversion and
so for now, I will enter the 180 readings value in the readings field.
This field is column B on my chart. If I look at the conversion that
has been done for me, I see that this returns a figure of 115..
I now go to the calculator itself and type in 6.4 and click on the
"calculate link. A result of 5.6 will be returned. So, according to the
lazy method of using the calculator, my HBA1C would be 5.6.
Let us see what the result would be if I used what I have come to call
the Master Average method. First of all, I run my diary in weekly
segments starting with my fasting readings on Friday mornings, and
ending with whatever the last reading is, that I record on each and
every Thursday. I do this because Fridays are the days when I and my
nurse care-giver sit down and talk about the progress I have made with
my management. It is also the day when I usually have my scheduled
appointment to see the diabetologist and so it makes good sense to
divide my weeks up like that. As at the 29th of March, for instance, my
180 readings average stood at 6.4 or 115 which gave me an estimated
HBA1C count of 5.6.
With the Master Average method, I would need to know what cells are
involved in my calculation, and, working on a strictly 3 months basis,
The period over which the calculation is to be performed, will start on
30 December and end on the evening of the 29th of March. To do this, I
would need to navigate my rows in Excel to find out which rows will be
affected. In the case of my chart, the rows affected are rows 1829 to
row 2098, both inclusive. On my chart the 180 readings column is
situated at row AA.
In order to calculate the master average, therefore, I would enter the
following formula in Excel "=average(aa1829:aa2098)" without the
quotes, of course.
On my chart, not the template, the result rounded to the nearest first
decimal, returns a value of 6.7, which converts to 121 in your terms.
This value is appreciably higher than my 180 readings average on the
29th of March. This is due to the fact that the 180 readings' average
only reflects the last 180 readings whereas the Master Average covers
the last 280 readings.
If I now enter 121 on the HBA1C calculator, it will return a result of
5.8. Therefore, according to the Master Average method, my HBA1C would
be 5.8.
I must just add that the figure of 121 makes good sense for although my
180 readings' average currently stands at 115, most of my recordings of
this average have been round the mid 120's, my highest recorded average
being 144 and the lowest recorded average being 108.
The lazy average is more inaccurate than the master average in that it
is based on the last 180 readings only, whereas the Master Average
takes all of the readings for a 3 month period into account.
The lazy method is also rendered inaccurate since, if you recorded less
than 180 readings in a three month period, the average because it
covers the last 180 readings, will reflect readings which fall outside
of the 3 months period and therefore, it cannot properly be said to be
a proper HBA1C, because it would then calculate more data than is
needed for the HBA1C.
The accuracy of both methods may be further enhanced or impaired,
depending on the frequency of testing. The more results there are for
inclusion in the Master Average, the more accurate the latter average
is likely to be. Conversely, the less data there is to include in the
Master Average, the more inaccurate the Master Average is likely to be.
It should be remembered that the glucose attaching to the haemoglobine
over a 3 month period is calculated on a random blood sample taken.
There is no control over choosing the sample that is taken in order to
perform the test, and so there is always going to be a reasonable
possibility of inaccuracy, but then, for that matter, as I see it, one
could technically argue that the proper HBA1C is not an accurate test
either. For the sake of consistency, therefore, if we reject the use of
an HBA1C calculator out of hand on the ground that it is inaccurate, we
should also then not be happy to receive an HBA1C result as being an
accurate result.
The frequency of testing should not be a problem for most people on the
list since I think that the majority of people here, test upwards of 4
times a day. I am a type II who is on diet and medication, and in my
case at least, it may be argued that my testing 3 times a day on
average, is excessive. However, this argument is counter balanced by
the fact that I am brittle, making the estimated HBA1C of 5.8 without
being on insulin, a grand achievement, and I must say, a huge credit to
my entire care team. I could not have done this on my own.
I personally feel that for me with testing 3 times a day, an HBA1C
calculator is called for, especially given the fact that I have very
volitile sugars. It has happened to me before today that for instance,
I would have a fasting sugar of 72 and a lunch time sugar of 248. It is
only because of building and suitably altering from time to time, the
very strict regime I am under, but when all is said and done, and I
speak for myself only, my views also echoing that of my support team,
that given the potential hassles of going onto insulin, I still prefer
my regime. While this regime is set about by some very awkward
inconveniences from time to time, I think that they would be less than
the inconveniences of going onto insulin. The HBA1C calculator,
therefore, is an imperative tool in my own management. It saves me the
anxiety of getting hassled if I record a few readings which are higher
than acceptable. I will only respond now if the HBA1C estimate changes.
By the way, you will find that the HBA1C estimate will remain very
constant if your readings are stable and sugars are under control. You
will however, se that the fractions that are generated in the
calculation of the Master Average will change from calculation to
calculation.
In my chart, for instance, the HBA1C average which we put at 5.8 has
remained the same for 8 weeks and when I perform the calculation for
this week, it is likely to stay the same again, even though I had a
relatively bad week as far as my sugars are concerned.
I must concede that if a person is Microsoft Excel and/or maths
illiterate, that the determination of a master average may be a bit of
a challenge which rules them out of the game. Nevertheless, as I
indicated on other diabetes forums as well, time permitting, I am more
than happy to do the work for a person if they submit their last three
months' readings to me, if readings are taken on a three times a day
basis, at least, and if each reading is accompanied by a 180 readings
average accompanying each reading. They don't even have to use my
template or calculate averages.
In addition to the Acu-chek calculator, I have looked at a number of
other HBA1C calculators on the web and for a number of reasons, have
found them not to be as user friendly as the Acu-chek. Furthermore, the
fact that the other calculators evidently use different formulae for
performing the estimate, necessarily also means that not all
calculators enjoy the same degree of accuracy of results. The Acu-chek
produces results which correspond more closely to my previous HBA1C
results than any of the other calculators do.
Personally, I feel that there is much to be said for putting a tool
such as an HBA1C calculator into the hands of the unqualified diabetic,
but there is also a lot to be said against it, and I feel that I have
dealt with a fair representation of both sets of arguments here. It is,
however, difficult to quantify the arguments in order to decide if one
is going to use such a calculator. The only real solution that I see to
the dilemma facing diabetics over this issue, concerns the very simple
and straightforward question: "What is it that I want from my
management regime?" There are no grey areas here: just the simple fact
of what it is you would want.
For myself, I must say that given the state of our primary health care
on the government system, you don't want to be a diabetic being treated
by some real idiots. The HBA1C calculator will be a valuable tool in
helping me to retain the services of a biocheneticist at a very reduced
rate. If I had to pay the full fee of the service I get there, I would
not be able to afford it. It will also be a valuable tool to help keep
my management under the control of a competent diabetologist.
I hope I have been able to shed some light on this subject.
Michael Park.
Confucious say: man who sit under tree is shady character.
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On 2012/04/02 22:23, d m gina wrote:
> I agree going to the doctor every three months is a must, and this old
> lady won't stop doing that.
> I always felt I had to believe in my meter because if I didn't then
> why bother to test.
> It sure would help the fingers if I didn't loll.
> thanks for sharing your thoughts.
>
> Original message:
>> I wouldn't trust any such calculator since accuracy depends upon the
>> details of data entry -- when and how often readings were taken, for
>> example. I don't even believe in the usefulness of meter averages.
>
>> Mike Freeman
>> sent from my iPhone
>
>
>> On Apr 2, 2012, at 7:46, d m gina <dmgina at samobile.net> wrote:
>
>>> Thanks Mike, I sure would appreciate it.
>>> Now I would love it if it were for the IPhone.
>
>>> Original message:
>>>> This one is quite simple. You type in your figures and press the
>>>> button.
>>>> The multiplication thing is purely applicable in the context of
>>>> persons
>>>> living outside of the USA. I will have a look to see if I can find a
>>>> HBA1C calculator where you don't need to do the calculations.
>
>>>> Michael Park.
>>>> I am not an expert, because "ex" means "has been" and "spert" is "a
>>>> drip under pressure".
>
>>>> Share files that are too large to send by email, videos and more.
>>>> Join me on DropBox by going to:
>>>> http://db.tt/mMDz7Zqz
>>>> or join Sheena at
>>>> http://db.tt/dhfrtNIv
>
>>>> For ministry needs, write us at biblical.counselling2008 at gmail.com
>
>>>> Please consider making a donation to NVDA, insuring that blind
>>>> people all over the world, will be able to afford access to
>>>> technology by going to
>>>> http://www.nvaccess.org/wiki/Donate
>
>
>
>>>> On 2012/04/02 02:45, d m gina wrote:
>>>>> I need something a bit more simple, where I can put in numbers or
>>>>> what
>>>>> you need to do and it would convert it for me.
>>>>> If it gets to complicated then I don't understand.
>>>>> Glad this works for you.
>
>>>>> Original message:
>>>>>> Hi there.
>
>>>>>> I am also sending copies of this email to some of my diabetic
>>>>>> friends in
>>>>>> South Africa, as well as to a South African diabetes forum to
>>>>>> which I
>>>>>> belong and although I am addressing a South African audience,
>>>>>> have still
>>>>>> tried to give this post a bit of an international flavour for the
>>>>>> benefit of everyone else.
>
>>>>>> Not quite sure how useful this is going to be to folks on the
>>>>>> community,
>>>>>> but I have discovered a tool which can give you a fairly good
>>>>>> idea of
>>>>>> what your HBA1C is going to be before you even go to the doctor. The
>>>>>> tool can be found on the Accu-chek web site for the United States
>>>>>> and is
>>>>>> situated at
>>>>>> https://www.accu-chek.com/us/glucose-monitoring/a1c-calculator.html#
>
>>>>>> I went searching for this tool in response to a question put by
>>>>>> someone
>>>>>> who belongs to one of the other international diabetes forums to
>>>>>> which I
>>>>>> also belong.
>
>>>>>> The only thing that you should bear in mind if you are going to
>>>>>> use this
>>>>>> tool, is that you will have to convert our MMol/L to mg/dl which
>>>>>> is the
>>>>>> measuring unit peculiar to the United States only, as far as I can
>>>>>> ascertain. In order to convert MMol/L to mg/dl, simply multiply our
>>>>>> numbers by 18 so that a reading of 6.0, for instance, would
>>>>>> translate
>>>>>> into 108 in US terms and 6.5 would translate into 117.
>
>>>>>> I have tried using the calculator, using my sugar averages from old
>>>>>> diaries and the reading compares well with HBA1C's I recorded in the
>>>>>> past.
>
>>>>>> What you should note is that the HBA1C figures in the USA work
>>>>>> out to
>>>>>> the same as the unit we use here, so that if your HBA1C would be
>>>>>> say,
>>>>>> 6.0 here, it will also be 6.0 in the United States.
>
>>>>>> If you do not live in the United States and you cannot do the
>>>>>> sums, I
>>>>>> would recommend a programable unit converter called Converber the
>>>>>> portable version of which can be downloaded from
>>>>>> http://www.portableapps.com
>
>>>>>> You will have to program the unit conversions for diabetes into the
>>>>>> program, but that is a relatively simple task to do. If you are
>>>>>> stuck on
>>>>>> how to do this, please feel free to write me and we can perhaps
>>>>>> arrange
>>>>>> to chat on Skype on the net and help you to do the conversion.
>
>>>>>> If you are stuck regarding getting the program, I think I have a
>>>>>> copy
>>>>>> here which I can send you.
>
>>>>>> Finally, the Accu-chek web site is screen reader accessible, and in
>>>>>> particular, and for the benefit of NVDA users, it is also NVDA
>>>>>> friendly.
>
>>>>>> --
>>>>>> Michael Park.
>>>>>> I am not an expert, because "ex" means "has been" and "spert" is "a
>>>>>> drip under pressure".
>
>>>>>> Share files that are too large to send by email, videos and more.
>>>>>> Join me on DropBox by going to:
>>>>>> http://db.tt/mMDz7Zqz
>>>>>> or join Sheena at
>>>>>> http://db.tt/dhfrtNIv
>
>>>>>> For ministry needs, write us at biblical.counselling2008 at gmail.com
>
>>>>>> Please consider making a donation to NVDA, insuring that blind
>>>>>> people
>>>>>> all over the world, will be able to afford access to technology by
>>>>>> going to
>>>>>> http://www.nvaccess.org/wiki/Donate
>
>
>
>>>>>> _______________________________________________
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>>>>>> for
>>>>>> Diabetes-talk:
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>>>>>>
>
>
>
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>>>>
>
>>> --
>>> --Dar
>>> skype: dmgina23
>>> FB: dmgina
>>> www.twitter.com/dmgina
>>> every saint has a past
>>> every sinner has a future
>
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