Understanding Diabetes Testing and Using A1c
Diabetes mellitus continues to challenge coaches who work with clients who use insulin or those who have metabolic disorders in which the body cannot make efficient use of glucose.
With Type I diabetes, no insulin is produced by the pancreas, so injections are required. Type I diabetes is usually referred to as insulin-dependent diabetes mellitus (IDDM), and usually will have onset earlier in life.
Type II diabetes is the non-insulin-dependent type of diabetes and usually occurs in middle-aged, overweight, sedentary adults. A more troubling trend exists whereby we see cases of type II diabetes showing up in children and adolescents.
The A1c Test
The A1c test has become a very common test to more accurately assess blood glucose levels by looking at an average value over a period of time. The A1c test was developed in the late ’50s and began to be used to monitor glucose control in diabetic patients in the late 60s.
The primary goal of those with diabetes is to both maintain and control their blood glucose levels as close to normal as possible. Another goal with this type of test is to minimize the complications caused by chronically elevated glucose levels to body organs. The A1c test provides information to determine the average values of blood glucose over a period measured in months. Sometimes, the A1c test is ordered as routine, and part of a general physical.
This test is used by your client’s physician to assess control of blood sugar in both diabetic and non-diabetic patients. A1c is frequently used to help newly diagnosed diabetics determine how elevated their uncontrolled blood glucose levels have been. It may be ordered repeatedly while control is being fine-tuned, and then at regular times during the year to verify that good blood glucose control is being maintained.
Although the A1c test has different uses, it is typically used to screen for and diagnose diabetes. It is also used to monitor those who may be pre-diabetic, but there are also times when the A1c test should not be used. When having discussions with clients who may be in this situation, it is important to not make the wrong recommendations.
Therefore, it is good to know typical protocols for all assessments done. That includes those not only done by you, as the certified wellness coach, but those that are typically done by qualified, trained health professionals. In addition to the need to know the scientific concepts involved, your client will also be looking to you to coach them. This might involve coaching their intellectual wellness, as you teach them about diabetes education. In this way, the wellness coach enhances or augments professional healthcare.
During this time, you may find that your client has a lot of questions about tests of this nature. It is not uncommon for clients to not have a clear sense of communication with their healthcare provider. It is vital for the wellness coach to yield to health professionals above them in all matters, yet still, be able to act as a coach and resource to the client. Be prepared for times when you may not always understand the methods of your client’s care provider.
Remaining judgment-free of all parties, in this case, the healthcare provider, is very important, because there may be information you do not know related to your client’s condition. Still, to complicate matters more, there are plenty of times when the client is unclear of what has been communicated to them by their health- care provider. When clients seek clarification from the wellness coach about health care matters outside of your field of expertise, you must refer this client back to their doctor for clarification. However, this provides a follow- up opportunity for the wellness coach during the next consult.
In another example of both the practical application and consideration of coaching skills related to coaching in the field, if you have an overweight client, who suspects she may be pregnant, encouraging this client to have an A1c test would be in error.
Similarly, your conversation skills would be important in this scenario: you have a client with Type II diabetes who also has asked you about iron supplements in the past. While the wellness coach is not always qualified to have discussions at this level, it is not unlikely that a client will ask you questions as though you were qualified to give them coaching in the form of guidance and direction.
Again, it is important to adhere to the ethics of wellness coaching by not stepping outside of your area of expertise. If this were to occur, we would run the risk of potentially persuading a client toward behavior that they were not ready to change yet. Since the A1c is contraindicated for someone with iron deficiency anemia, it would be negligent to coach the client about its use as a tool to help them manage their diabetes. Providing the client with guidelines would be very appropriate for this client, however.
Depending on the type of diabetes that your client has, how well it is controlled, and the doctor, your client’s A1c may be measured 2 to 4 times each year. The American Diabetes Association recommends testing A1c at least twice a year. When someone is first diagnosed with diabetes or if control is not good, A1c may be ordered more frequently.
As it relates to the client, understanding diabetes is important because it is becoming more common and the risk factors that contribute to diabetes mellitus seemed to be pervasive. Excessive weight is a factor because it increases the cellular resistance to insulin that is produced by the pancreas, so as a result, more insulin is required to affect the metabolism of sugar for use in the blood for the cells. By contrast, physical activity decreases insulin resistance, making cellular membranes more permeable to glucose.
More than 100 million U.S. adults are now living with diabetes or prediabetes according to the Center for Disease Control in the USA). Sometimes referred to as metabolic syndrome, there are serious long-term health consequences seen among diabetics. Primarily, these involve degenerative disorders of blood vessels and nerves.
Diabetics who suffer premature death are usually victims of cardiovascular lesions or accelerated atherosclerosis. Heart attack and stroke frequency is also higher among diabetics when compared to non- diabetics. At least 68 percent of people aged 65 or older with diabetes die from some form of heart disease and 16% die of stroke.
Adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes.
The American Heart Association considers diabetes to be one of the seven major controllable risk factors for cardiovascular disease.
With diabetes, the arterial system seems particularly susceptible to damage from atherosclerosis. This has a direct effect on the kidneys, eyes, and legs, due to the vascular needs of these body parts. Among adults, diabetes is the leading cause of blindness in the United States. If complications spread to extremities (legs and feet), these conditions may lead to gangrene, necessitating amputation of affected tissues or limbs.
Besides circulatory problems seen in diabetics, degenerative lesions in the nervous system have a tendency to develop, leading to multiple diseases that result in the dysfunction of brain function, spinal cord, and peripheral nerve system.
Managing Diabetes with Lifestyle Changes
Although medical science has not been able to mitigate the biological mechanisms responsible for long-term vascular (or other) complications seen in diabetics, these complications can be controlled and managed by leading a tightly regulated and controlled lifestyle, thereby keeping diabetes mellitus under control. Control of diabetes includes dietary strategies, physical activity, body weight control, and medications as prescribed.
The best news for your client who is diabetic is that those diagnosed with Type II diabetes can change or reverse their condition. Since multiple health studies have shown exercise to reduce the risk of developing Type II diabetes, it should, therefore, be the best practice as a protective strategy against Type II diabetes. Clients with lifestyle risk factors, family history, or excessive abdominal fat (greater than 40 inches) may need to work on multiple wellness concerns in order to protect themselves from the onset of Type II diabetes.
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That’s it for now.