What is your HbA1c?

 Sugar / Oh, honey, honey / You are my candy girl / And you got me wanting you The Archies.

I had no cause to worry about diabetes all these years. Never even entertained a passing thought about sugar, other than adding two heaped teaspoonfuls to my tea or coffee every morning or evening. That said, I am not one of those who has a ‘sweet tooth.’ While I have indulged in the odd jalebi, sandesh, Mysore pak, kaju barfi or sugared doughnut, I have never hankered after sweets. I could take them or leave them. Until that is, one of my friends casually asked me what my HbA1c reading was. I had no idea what he was talking about.

‘HbA1c?’ I repeated. ‘What might you be blabbering about? Sounds like some kind of chemical formula. You have the advantage of me, my friend.’

My friend was taken aback. ‘What, you have never heard of HbA1c? Don’t you take your annual blood tests? At the very least, you would have checked out your fasting and post-prandial sugar. Most of us are obsessed with sugar levels nowadays. The papers are full of it.’

‘All that is fine and dandy, but I still do not know what HbA1c is. Pray tell.’ Seriously, I did not know the first thing about it.

My dear friend seemed to be a bit of an expert on matters medical. Every family has one. ‘It gives you a three-month average assessment of your sugar reading. This is a far more accurate way of assessing whether your blood sugar levels are normal, pre-diabetic or full-blown diabetic.’

‘And a random fasting or post-prandial test is not accurate enough?’ I asked.

‘Not really, because people tend to keep away from sweets completely a couple of days before testing which will give a skewed reading that all is well. Crafty. The medicos are wise to this ruse. That is why doctors insist on a three-month test.’

‘Are you sure you’re not a doctor? You could have fooled me.’ I can be biting when the mood takes me.

The long and short of this conversation was that I was persuaded to take an HbA1c test and discuss the results with my GP. Armed with the report, I waited for my doctor to give me the bad news.

The doc read the blood report carefully as there were other parameters that were tested, finally laid the sheet down on his table, removed his spectacles and shook his head slowly east to west and back again, filmy style and said, ‘Hmmm.’ Always a bad sign, this non-verbal communication.

I was beginning to get tetchy. ‘Well, what is it Doc? You can tell me. I can take it.’

‘Your HbA1c reading is 5.9,’ he declared somewhat gravely.

‘Is that bad?’

‘It’s not great but as Shakespeare said in a different context, “tis not as deep as a well nor as wide as a church door, but ‘tis enough, ‘twill serve.’” He looked rather pleased with himself, my well-read physician.

On the other hand, I was miffed. ‘Doc, if it’s all the same to you, can we shelve the Shakespeare lesson for some other time?  You can also skip all that guff about pancreas, insulin etc. Tell me where I stand on the diabetes scale.’

‘You my friend, are kind of between and betwixt. Neither fish nor fowl. You are not a confirmed diabetic but neither are you totally free of the scourge. The threat perception is mild but it is lurking, waiting to pounce. It’s a sort of warning shot across the bows that you should  take heed. Take more care of what you eat, and take a critical look at your sedentary lifestyle. Exercise is the order of the day, apart from regulating your diet. You are what you eat, as they keep saying. You are at the pre-diabetic stage and need to go easy on excessive starchy foods and opt for sugar-free substitutes to spike your beverages. Incidentally, diabetic sweets are available these days.’ He had said his piece.

‘Diabetic sweets? During this festive season with Deepavali just round the corner? I am told they taste like mud.’

‘But it’s good, healthy mud. Do not mock things you know nothing about.’

It was now my turn to go ‘Hmmm,’ rather thoughtfully. ‘But Doc, I am fairly conservative when it comes to my eating and drinking habits.’ I raised my glass of water and said, ‘Mud in your eye, Doc.’

Ignoring my jokey toast, he said, ‘Drinking habits, you say? I hope you are imbibing not more than a peg or two. And rum is strictly a no, no. Comes from sugarcane and molasses’ he continued, raising his eyebrows needlessly.

‘Why do you jump to the conclusion that the word drink automatically suggests alcohol? Apart from the rare, celebratory glass of wine, I am almost abstemious. I was referring to juices, soft drinks and the like.’ In case you are wondering at my somewhat irritable and over-familiar manner of speech, the physician was an old acquaintance of mine and I could afford that liberty.

‘Aerated?

‘Pardon?’ I was a bit lost.

‘Soft drinks, do you go for Coke, Pepsi and so on?’

‘You hardly expect me to get through a pizza without periodic gulps of Coke, do you? It’s a junk foodie’s sine qua non.’

‘Ah ha, pizzas eh? Well, I’ve got news for you. Put a stop to pizzas or hamburgers and no more Cokes or any other form of sugared, aerated drink. Got that? We need to bring your HbA1c down to 5.7 or under. Sine qua non, indeed!’ He was clearly unimpressed by my smattering of Latin.

‘How about Coke Zero?’ I countered.

‘No means no. They are all fizzy.’ He was going livid. I was worried in case he needed attention.

‘Ok, ok, no need for hysterics. After I hit the magic 5.7, I can binge? You know that old Julie Andrews song? Just a spoonful of sugar makes the medicine go down.’

‘Good grief man, I don’t allow singing in my chamber. Anyhow, that song was meant for toddlers. Where did you unearth Julie Andrews from? What are you, a teenage adolescent? Now look, I have plenty of patients waiting. Can’t spend the whole day chit chatting with you. Here is a list of do’s and don’ts. Read it carefully and quickly and see if you have any questions. And less of the Mary Poppins stuff, please.’

I ran my eye down the printed sheet of paper. ‘Haven’t tried red rice or millets before. Might be worth exploring. Our Prime Minister speaks highly of millets. I must confess he looks in the pink of health. Eats a lot of mushrooms too, I believe. Hullo, what’s this? No more idlis? Come on Doc, all patients in hospitals in south India gorge on idlis, post op. Idlis are practically a religion with us.’

The man with the stethoscope gave me a knowing look. ‘I thought you will say that. Look, just go easy on the rice idlis. Rava or semolina idlis, upma etc. are fine.’ I thought a rava idli is an abomination, like egg dosa but I chose not to argue.

‘But Doc, even Shashi Tharoor sings paeans of praise to the humble idli and he looks pretty fit to me, barring a few extra inches in the equatorial belt, as my school master used to describe the midriff area. Perhaps he could lose a kilo or two, but other than that even Adonis might envy his looks. The MP from Thiruvananthapuram, as is his wont recently said, “A truly great idli is a cloud, a whisper, a perfect dream of the predictability of human civilisation.” He went on to compare our idli with a Beethoven symphony, a Tagore poem, a Husain canvas, a Tendulkar century and much else besides. He is a wordmeister, after all, if you’ll pardon the coinage. He might have got slightly carried away there, but we can put it down to poetic license and a bit of gallery-playing. The Keralites love their idlis.’

My doctor friend exhibited unwonted patience while I prattled on. Finally, he got a word in edgewise. ‘Perhaps you should consult Dr. Shashi Tharoor regarding your pre-diabetic issue. I think he is a doctor of something or the other. You are clearly wasting your time here.’ His wounded sarcasm was not lost on me. I felt I should make peace and ask him just a few questions on my diet before being shown the door.

Sorry about that Doc. I was just trying to keep the conversation at a frothy, light-hearted level. So, let me make a check list of all the things you have declared a resounding ‘No’ to. Polished white rice, sweets of any kind, carbs including starchy stuff like potatoes, all deep-fried stuff and a further 27 items which I shall not bother listing out.  In short, as some smart aleck said, “Everything I like is illegal, immoral or fattening.” No, no, no to all of them. Perhaps I should dub you Dr. No.’

For the first time, the good doctor’s face was wreathed in a smile. ‘You haven’t forgotten your Ian Fleming, I see. In that case, I will stretch a point. You can have the odd drink, preferably a vodka martini. Shaken, not stirred.’

I left his chamber in good spirits, thinking pleasant thoughts of the man they call Bond. James Bond.