Again, this woman's experience is lamentably typical. By the time insulin was started, she was quite old and likely burdened by diabetic complications. The horse was out of the barn, so to speak. This pattern of late diagnosis, ineffective treatment, and too many complications must be changed. Just as important, we have A 1c to measure success for both individual cases and for systems of health care.
Random glucose is far too variable, and high values are routinely ignored.
Assessing fasting glucose is surprisingly difficult. Patients must come to the lab or office early in the morning, and often confound the test by late evening meals or early morning coffee with milk. Glucose tolerance testing is even more problematic. It requires fasting, an early appointment, several hours, some discomfort, and considerable cost. Whether A 1c measurement should replace the other ways to make the diagnosis is now under debate.