DEAR DR. DONOHUE: I am a 46-year-old professor, trying to avoid type 2 diabetes but fighting a strong family history of it. My paternal grandmother, my father and my mother all have it. I am 5 feet 2 inches, 123 pounds, eat little meat or “bad” foods and lift weights and do cardio exercise five days a week. Yet my A1C creeps up every year – 5.4, 5.5 and most recently 5.6. My cholesterol is normal, as is my LDL cholesterol and triglycerides. What can I do to slow or avoid diabetes that I am not doing? – M.H.

ANSWER:
You’re winning the fight, professor. You’re making an A plus.

A1C or HbA1C (hemoglobin A1C) is a blood test that tells how well a person’s blood sugar was controlled in the previous four months. It has been used to monitor sugar control. It’s about to be used to diagnose diabetes. Hb, hemoglobin, is the stuff inside red blood cells that grabs onto oxygen as blood courses through the lungs. It releases oxygen when blood reaches parts of the body in need of it. Sugar sticks to hemoglobin – the HbA1C is hemoglobin with sugar on it, sort of like a glazed doughnut. A HbA1C of 5 percent corresponds to a blood sugar of 97 mg/dL (5.3 mmol/L) – normal. Those increases of 0.1 are insignificant. You’re doing fine.

You’ve done all the things possible to stave off diabetes. Your weight is perfect. You’re physically active. Your diet is admirable. There’s nothing more to do.

For others, prevention of diabetes entails not allowing yourself to become overweight, adopting a diet low in fats and high in fruits, vegetables and whole grains, and staying as physically active as you possibly can.

The booklet on diabetes explains type 1 and type 2 diabetes, what symptoms to look for and how diabetes is treated. Readers can obtain a copy by writing: Dr. Donohue – No. 402, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My question is about CA 19-9, a tumor marker for pancreatic cancer. Both my parents died from this cancer. The GI doctor recommended that my siblings and I be tested for it. My sister and I had it done. Her CA 19-9 was 4; mine was 65. I understand that 37 is normal. I had a repeat test, and it was 63. After three months, I had another test. It was 67. My doctor said it was stable and not to worry. Can you explain the test and the numbers? – B.K.

ANSWER:
Some cancers produce substances that appear in the blood and are used for cancer detection. Those substances are tumor markers. CA 19-9 is a tumor marker for pancreatic cancer. No tumor marker is the perfect test, and that holds for CA 19-9. It can be positive when there is no cancer and negative when there is cancer. It’s a help, but not always a reliable indicator of cancer or its absence.

You do need to be followed closely, since both of your parents had this cancer. The truth is that the best way to detect pancreatic cancer remains uncertain.

I tend to agree with your doctor. Your values have not changed. Those slight differences are not significant. If cancer were present, they should be much greater. If you develop any signs or symptoms that might remotely indicate pancreatic cancer, you have this baseline study to gauge what CA 19-9 is meaningful for you. You also could have, at that time, an ultrasound examination of the pancreas or a spiral CT scan of the gland.

DEAR DR. DONOHUE: We heard so much about peanut butter and were told not to eat it. Is it safe to eat now?

Where’s the best place to buy it? – I.R.

ANSWER:
Peanut butter now on the shelves of grocery stores is safe. I am eating it. Peanut butter, for me, is one of life’s basic food groups.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.


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