Two gaps in diabetes care, and what you can do about them
Many people take herbal or traditional medicines alongside prescriptions without every doctor knowing, and an HbA1c test shows only an average over about three months. Telling each doctor everything you take, and looking at your numbers between tests, helps close both gaps.
Two problems come up again and again in diabetes care. Each affects a very large number of people, and each is easy to miss.
Two kinds of medicine that don't talk to each other
Across South Asia and well beyond it, many people use traditional medicine alongside modern prescriptions. A cardiologist prescribes a blood thinner, and a family practitioner of Ayurveda gives a preparation used for generations. Both act in good faith, and often neither knows what the other prescribed.
A review of 22 studies of older adults found that taking herbal products alongside prescription drugs is common, although reported rates varied widely. The interaction reported most often was a possible risk of bleeding when ginkgo, garlic or ginseng was combined with aspirin or warfarin (Agbabiaka et al., Drugs & Aging, 2017). A separate review of trials with warfarin found the evidence was too weak to draw firm conclusions for many herbs (Choi et al., PLoS One, 2017). That uncertainty is the reason to mention them.
What you can do
- Keep one list of everything you take, including herbal, Ayurvedic, Siddha and Unani preparations and supplements.
- Show that list to every doctor and pharmacist you see.
- Don't stop a prescribed medicine on your own. Talk to your doctor first.
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A single number every three months
Most people with diabetes get an HbA1c test every few months. It's a useful average, but it can't show that your sugar was steady for six weeks and slipped after an illness. Two people with the same HbA1c can have very different days.
Glucose sensors add detail that an average can't. An international consensus sets out targets such as time in range, the share of the day your glucose stays between 70 and 180 mg/dL (Battelino et al., Diabetes Care, 2019). Sensors, wearables and lab results each tell part of the story, and it helps to see them together.
What you can do
- Ask how often your HbA1c should be checked, and write down the dates and results.
- If you use a sensor or a meter, note what changed around any stretch of high readings.
- Take those notes to your next appointment.
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Common questions
Should I tell my doctor about herbal or Ayurvedic medicines?
Yes. Keep one list of everything you take and show it to every doctor and pharmacist, because some herbal products may interact with prescription medicines.
Can herbal products interact with blood thinners?
A review of older adults found possible bleeding risk with ginkgo, garlic or ginseng taken with aspirin or warfarin was the interaction reported most often. Evidence for many herbs is limited, so ask your doctor.
What does HbA1c not show?
It is an average over about three months, so it can't show day-to-day swings or when your control changed. A sensor or regular meter readings add that detail.
Sources
- Agbabiaka TB et al. Concurrent Use of Prescription Drugs and Herbal Medicinal Products in Older Adults: A Systematic Review. Drugs Aging 2017;34(12):891-905
- Choi S et al. A systematic review of the pharmacokinetic and pharmacodynamic interactions of herbal medicine with warfarin. PLoS One 2017;12(8):e0182794
- Battelino T et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care 2019;42(8):1593-1603
Last updated: . Educational information, not medical advice. Talk to your doctor before changing your treatment.