Diabetes Wise

Changing How A1c Values Are Reported

I'm the kind of person who usually embraces change. But only when that change is clearly beneficial or positive in some way., rather than just the pointless act of change for change's sake. My initial reaction to the news that A1c values in the UK will no longer be reported as percentage values is "why?", and I'm struggling to identify a positive reason for the move.

The new unit of measurement will be millimoles per mole, or mmol/mol, rather than existing percentage measures. A current result of 6% will equate to 42mmol/mol, 6.5% to 48mmol/mol and 7% to 53mmol/mol. The unit of measurement presents a potential problem to regions of the world that measure blood glucose in mmol/l, which includes the UK. Since the mole is a fairly obscure scientific measure in everyday use, you can bet a lot of people will be confused by mmol/mol and mmol/l. And if your 3 monthly report suggests your average BG has been 48mmol/l, you're going to be a bit worried!

So why the change? According to the official literature, it will make comparing results from different laboratories easier, but something doesn't add up.

There is no mention of changing the way in which A1c is actually measured, or the calibration and standardisation of results. In fact, the same piece of loiterature states "It is just a different way of expressing the same thing."  The literature intended for healthcare professionals also says that there is no actual change in calibration methods, just in the units to make comparing results to an existing calibration set easier.

But why pass confusion and change on to patients who are used to the current system and clear about their goals and targets? If this is a simple conversion between numbers, why not apply the conversion at the time it's needed? Let the scientists and clinicians convert the existing numbers to the units they want to use instead of asking patients to have to convert their new results into a currency they are familiar with.

Am I missing something?

Arctic Adventure

Q. How do you go to the toilet in an outdoor long-drop in the arctic?
A. Quickly!

Q. How do you go to the toilet outdoors in the arctic when there is no toilet?
A. Even more quickly!

I know this, because last week I, and my diabetes, took on one of our toughest challenges yet spending a week dog sledding and cross country skiing across the arctic wilderness. I experienced both the above situations, but I had the time of my life. It was, without a shadow of a doubt, one of the most amazing things I've ever done.

We were two hundred miles above the arctic circle in Northern Sweden. For a Brit, unaccustomed to heavy winter snowfall, the landscape is like something out of a fairytale. Several feet of snow and trees dripping with ice crystals that sparkle in the few weak rays of sunlight that make it over the horizon for just a few minutes each day. Rivers and lakes that are frozen solid and topped with deep powder, an endless white expanse stretching further than the eye can see. On our very first evening, as temperatures hovered at minus 25 degrees centigrade we were treated to a glimpse of nature's very own magical light show - the aurora borealis.

Accommodation for the week included a wilderness camp with no running water or electricity, and outdoor toilets, a snow hole (also known as an igloo) that we built ourselves, and also a night in the world famous original Icehotel in Jukkasjärvi. The Icehotel is made, as the name implies, entirely from ice with the interior kept at a constant minus 5 degrees to stop the whole thing melting. I've long wanted to visit, but our stay confirmed that amazing as it is, it's a once in a lifetime thing!  We slept in arctic rated sleeping bags atop reindeer skins on an ice bed. Although the bags were warm, this was by far the least comfortable nights sleep of the whole trip, as the sleeping bags were pretty claustrophobic and every time I rolled over I thought I would suffocate. My face was also pretty cold for most of the night. The ice hole, by comparison, was positively cosy. Ian and I even managed a midnight feast.

Of course, the main reason for being out here was the dogs. As far as dog sledding goes, there is really only one rule - never, ever let go of your sled, or your dogs, unless they are tied down. Otherwise it's the last you'll see of them! These dogs are born to run. As we harnessed our teams up on the first morning, they were going crazy, straining in their harnesses and barking wildly, excited and keen to get out of the trail. You have no control over the throttle (the dogs) just the brakes. The moment you let them off the dogs are away and immediately silent. I can't find the words to describe the magic of the silence of the arctic punctuated by the panting of the dogs and the sushing if the runners over the ice. Weaving through the trees of the forests and then across the open lakes and rivers.

My team - Queen, Yudis, Dick and X-Ray, worked exceptionally hard for me and I very quickly felt in tune with them. X-Ray was the youngest, at just over a year, and brand new to team running. He had a reputation for eating his harness and being a general handful, but somehow he was still totally lovable!

Of course it isn't all peaceful. It can be hairy at times. Dog sledding is the only form of transport I've come across where you don't brake coming in to a corner, as it's far more stable if you let the dogs take you round at full pelt. Stopping to test my blood sugar and eat was hard work, since you must keep one hand on the sled at all times unless it's properly anchored. I was fortunate not to fall at all, but came close when I was dealing with a CGM calibration alert. I had my snowsuit unzipped and managed to cancel the alarm but as I tried to get the pump back inside the suit, the dogs strained in their harnesses in response to a team ahead of me pulling away. I was momentarily unbalanced, but managed to hold on. I threw the pump clumsily into my suit and managed to get the zip done back up!

We also had the chance to try out cross country skiing and spent the last day hurtling down the frozen Torne River on a snowmobile. At one point the ice beneath us of a small inlet began to break up. What we didn't know at the time was that a snowmobile can travel 30m over water at full throttle. Fortunately we didn't sink, but feet got distinctly wet! We also had a chance to try ice fishing, which revealed the magnificent thickness of the ce on the main lakes. Fortunately we weren't reliant on catching anything for our dinner, or we'd have been hungry. Much of the food was reindeer or moose based, accompanied by delicious Swedish Polar bread.

Diabetes wise, the trip went great. I'd be lying if I said I wasn't worried before hand. I took a mountain of glucose gels and miniature bags of jelly babies, not to mention cereal bars. I kept my kit in an insulated pocket in my snow suit and tested frequently. I also loaded up the thigh pockets on my suit with glucose and food each day. My control wasn't brilliant, but I avoided any spectacular lows or highs that made me feel unwell. Trading off on my control for this week was entirley worthwhile. It was once in a lifetime, and if I died next week I'd be so glad I got to do it.

Q. What should you say to anyone who thinks diabetes might limit your lifestyle?
A. It doesn't have to!