Exclusive Interview from AACE Orlando
Steve Freed: So you keep saying that it’s important to keep the blood sugars normal. So what is a normal A1C and then what should the A1C be for a person who wants to get pregnant? And for a person who becomes pregnant?
Dr. Jovanovic: The normal A1C is less than 5.3%. For a woman with type 1 diabetes she’s asking the question of what’s the A1C that will prevent congenital anomalies, or birth defects and probably that’s an A1C less than 5.8%. Because, as the baby is forming and developing, two cells become four cells, but they won’t if the blood is sticky with a lot of sugar. Two cells will become three cells will become five cells, and that’s how you make a malformation, is too much sugar in the blood stream. Cells need to have a media that has almost no sugar in it, so that the cells can divide. So actually to prevent malformations is harder. So women with type 1 diabetes really need to be told to plan pregnancy, normalize their blood-glucose, and then have permission to get pregnant. And the best way to do that is to use the basal body temperature thermometer, so that you know that this month your A1C is normal, your blood sugars are great and this month you can go for it. But then you have to know exactly when you’re ovulating because it’s not fair to work that hard and miss the opportunity. So I usually tell them to buy the thermometer that tells them when they’re ovulating, because the temperature actually changes just right before the egg is popped.
Steve Freed: It’s interesting what you say that a normal A1C for a healthy person is 5.3. ADA says it should be below 7, AACE says it should be 6.5 and that’s for normal. But we’re talking normal, and now we’re talking pregnancy. So you’re feeling obviously a normal A1C is a good thing and that people should have an A1C and obviously it’s individualized, you can’t say everybody, you know, if you’ve had diabetes for 30 years you’ve got seven morbidities, you’re on 32 medications, and an A1C of 9, it can’t be dangerous obviously to put it down quickly.
Dr. Jovanovic: There is no exception. I’m not saying you have to put it down quickly, but you can’t say gee I’m 90 and therefore I don’t have to take care of my diabetes. You probably will live till a 110 and if you don’t take care of your diabetes you’re going to be in a nursing home blind with no feet and that’s going to be more health care costs. There is no exception. A normal blood sugar has to be the goal for everybody, from birth until death.
Steve Freed: That’s interesting, I really appreciate that because I don’t think I’ve ever heard another doctor or medical professional, diabetes educator, dietitian say that we should all have A1Cs at 5.3% or close to it. And my personal feeling is that with all the new treatments that we have available plus insulin because that’s a no-brainer, but people don’t want to go on insulin. With all the new technology with all the CGMs and with everything that’s available that there’s absolutely no reason why anyone in this country should have an elevated blood sugar. Yet I would say if we knew what the average blood sugar was for everybody with diabetes in this country, because a lot of people don’t go to doctors, it’d be over 90%.
Dr. Jovanovic: That’s true. That doesn’t make it right.
Steve Freed: But how could that be if we have all this knowledge and all this technology. It just it’s kind of mind boggling and I’ll sit down with a patient and their A1C is 9.7 or 8.5, and there’s absolutely no reason. Number 1 is they don’t even know what a carbohydrate is, so that certainly, education is a key component to control your diabetes, because without the education you’re doomed for failure no matter what happens. Because I just… once a person knows how to read a food label, they can lower their A1C significantly just with knowledge.
Dr. Jovanovic: See you can give my talk.
Steve Freed: So getting on to, some of the tips, because you’re so knowledgeable when it comes to diabetes for the general practitioner, for the patient. What are some of the key things that you can share that will help other medical professionals really come to the point that we need to be much more aggressive when it comes to diabetes.
Dr. Jovanovic: Well, first of all, I think physicians don’t realize that every woman in her child-bearing years could get pregnant. So if a physician is give an ACE for hypertension, he really has to ask the woman are you on birth control pills? Because if she gets pregnant and she’s on a drug that will cause a malformation, he’s liable, so the first thing a physician really has to know is that women in their child-bearing years need to be asked the question are you going to have any more babies? No, no, no, doc. If you’re not, are you on birth control? They might say something like, well gee I have my tubes tied or I don’t have a uterus, the physician can relax. But if a woman says, well I don’t want any more babies but still doc, I want you to take care of me, You have to prescribe a birth control pill and then you can use any drug you want. Because a woman could always get pregnant and not tell the physician, who is then liable, because he’s prescribed the drug that is not safe in pregnancy. So I think that’s the one thing you can tell physicians is think pregnancy first before you think anything else.
Steve Freed: What are some of the other things that you like to have them be aware of?
Dr. Jovanovic: Not to reprimand the patient. When the patient comes to the doctor and asks for help, the doctor shouldn’t be saying, oh your blood sugars are terrible. But the truth is the doctor has to look at the blood sugars. Women work really hard to write down all of their blood sugars and the doctor never looks at them. I tell women to write down the last three days and put them under the nose of the doctor and make the doctor look at the blood sugars because she knows she needs help with her fasting or help after breakfast. But the doctors never look at all this. Although sometimes what they do is they take the glucose monitor and push the button, but the readings are all backwards. So unless he’s writing them down backwards, he won’t be able to know which blood sugar belongs to what. So she has to write down her blood sugars before she goes to the doctor and she has to ask the doctor to look at the blood sugars and help her with sugar control. And he says, well, you know, we’ll do that next time. That’s not why she’s there. She’s there to ask for help and he has to help her with her blood sugars. So that’s the thing that you need to do. And usually I ask my patients, you say you saw Dr. Jones while I was out of town, did Dr. Jones look at your blood sugars? She said no and I had them under his nose.