Doc: Reader with high A1C may have to give up desserts
Dear Dr. Roach: As a 67-year-old male in good health, should I be concerned about a (fasting) A1C of 5.9 percent? This is the first time I have had this test run. I am 5 feet, 4 inches tall and weigh 122 pounds. I do two hours of strenuous aerobic exercise at least five days each week. There is no diabetes in my family. My physician says I should “avoid sweets, desserts and starch in my diet.” I am a vegetarian with minimal dairy consumption; I don’t smoke or drink; and I don’t care to give up one of life’s pleasures. I don’t overdo sweets, but I do enjoy them. I was thinking of getting a glucometer and tracking my sugar levels. This year, my blood glucose after a 12-hour fast was 93, similar to previous levels.
Dear K.C.: The A1C level is a measure of average glucose over the past few months. A normal level is between 4 percent and 5.6 percent. A level between 5.7 and 6.4 percent is prediabetes, and 6.5 percent or higher is diabetes.
Looking at your case, an average glucose of 93 would correspond to an A1C of 4.9 percent; an A1C of 5.9 percent is an average glucose of just over 120. That’s a big discrepancy. I suspect your sugars after eating are much higher than the fasting sugar you had measured. The other possibility is that the A1C is wrong; that can happen in unusual circumstances.
I’m afraid I may have to agree with your physician’s dietary advice. I admit that I am surprised that your A1C is as high as it is considering your height, weight and exercise habits, especially with no family history. I certainly would get the glucometer and check your sugar levels one and two hours after eating. That way, you can find out whether they really are going up after eating, and you can identify the foods that are the most problematic for you.
Dear Dr. Roach: My son-in-law smokes a lot of marijuana in the presence of my daughter. I recently read in your column that smoking marijuana can cause anxiety problems. Can this happen to my daughter, who is inhaling passive smoke from his heavy use? They live in a small house without much ventilation. She has had worsening anxiety over the past few years that they have been together, and I wonder now if it’s the passive smoke from marijuana that is causing her anxiety.
Dear Anon.: Secondhand marijuana smoke can have health consequences. The smoke is irritating and may damage the lungs (especially developing ones), and the active compounds in the smoke can have adverse effects on memory and coordination among those who are exposed to the secondhand smoke. It also can cause a positive drug screen. It is plausible that it may cause anxiety, but there might be other reasons for that.
Adults can make a decision about using marijuana for medical or recreational uses (at least in states that have legalized it), but children exposed to secondhand smoke cannot.
He should not smoke in the house. That is true for both marijuana and nicotine.
Email questions to ToYourGoodHealth@med.cornell.edu.