[Diabetes-talk] HBA1C calculators.

[d m gina]

Hi Mike,
I am pleased this method works for you.
I am pleased something is out there, but for me to understand what you 
are babbling about, I don't, so as long as it works for you that is 
what is important.
This would be something I would have to work with someone locally.
Then they could brake down what I need to learn.
Have fun and stay well.

Original message:
> 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.

> 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
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> For ministry needs, write us at biblical.counselling2008 at gmail.com

> Please consider making a donation to NVDA, thereby insuring that blind 
> people all over the world, will always be able to enjoy their universal 
> right to free access to technology. Go to
> http://www.nvaccess.org/wiki/Donate



> 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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>>>>>>> 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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-- 
--Dar
skype: dmgina23
  FB: dmgina
www.twitter.com/dmgina
every saint has a past
every sinner has a future

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