Yesterday, I responded to the question about "things you wish your doctors knew about diabetes and the daily task of living [with it] by mentioning that many healthcare providers' knowledge of diabetes is incomplete and/or out of date. Rather than be a part of the problem, I've proposed a first-draft solution — some things I would put into a Continuing Medical Education (CME) syllabus to fill in some of those gaps. I'm sure I'm missing rather a chunk of stuff, but then again, this is a first draft.

If I were to develop a syllabus to fill in the gaps in professional diabetes education, as I perceive they exist today, these are some of the things I would consider:

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You may be at risk for diabetes if...

Anyone else here bristle when you are presented with these statements?

I mean, no $4!†, Sherlock. I have diabetes. I am no longer at risk for the condition, it exists in me.

So why does my lab's A1c, if it exceeds 5.8, say "You are at risk for diabetes" rather than "You are within guidelines for someone with diabetes"? Did my diabetes suddenly go away just because I don't need to take pills or shots to control it?

Now, I know I'd be really peeved if I didn't have diabetes and a 5.8 A1c read, "You have excellent control of your diabetes" -- but come on, some contextual information, please -- or better yet, placing 5.8 in the "higher than reference normal" category and letting my doctor do the talking.

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For several months, a bunch of us have taken part in Wednesday night Diabetes Social Media Advocacy (#dsma) chats on Twitter. Run by Cherise Shockley, these sessions are about an hour long and cover a number of predesignated topics ranging from support groups to diabetes-related conferences to relationships to insurance issues. A week ago this past Wednesday, talk centered around the glycosylated hemoglobin (HbA1c) test: how important it is (or should be) in determining our treatment, how accurate it is as a measure of our diabetes control, whether or not we consider current best-practice A1c goals to be realistic or not (and why), and what sort of self-treatment we use to achieve (or try to achieve) those goals.

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From time to time, a heated discussion will erupt around the terms and phrases "prediabetes", "borderline diabetes", and "beating diabetes". The basic gist of the debate goes like this:

Someone will post that he was told he has "borderline diabetes" or "prediabetes", or that he had type 2 diabetes, but since he changed his diet, got off his diabetes medications, and has normal lab results, he has reversed or cured his diabetes.

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About a year ago, my PCP's office decided I needed to make separate appointments to have my blood work drawn, a week before my PCP appointments, extorting an extra co-pay so that my doctor and I can have some meaningful interaction (my insurance requires the lab work to be sent out, with about a five- to seven-day turnaround). There's nothing unusual about the blood work -- just the standard glucose panel (with HbA1c), metabolic (liver function) panel, lipid panel (cholesterol), blood count, and urinalysis.

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That's right, after LOWERING my dosage of metformin (generic glucophage) six months ago; my HbA1C went DOWN to 5.5 from 5.8.  Yes, I brought my average blood sugars DOWN by reducing my medication and increasing my cardio and strength training.  It's only a decrease of about 8 mg/dl but that's an average over 24/7.  AND I went from 2000 mg metformin to 1500 mg.   I know "they" say it can and should work that way, but I'm the first to admit I didn't believe it.  (Or that was my excuse for not trying harder).

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