101 surprising things I learned about A1C’s this week: diabetes reflections 11

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 101 surprising things I learned about A1C’s this week: diabetes reflections 11The A1C is a critical number used by doctors  to determine the long term effectiveness of ones diabetes self management. To many mine included, this is the number they zero in when determining how good or bad one is doing.

My goal for the a1c has been 6.5% and I have been quite consistent in achieving that number until a few months ago when things started going wrong.

Test results after that fateful Endo visit  in august, had  my a1c’s at 9.5%  and needless to say I was shocked and devastated, I knew my control was slipping but, I did not expect it to be that bad and I sure wasn’t looking forward to seeing the satisfying I told you so look from my Endo. But the number only acted as motivation to get back on track, the changes I made to my diabetes management helped me lower the number by a full % point 4 weeks later and it has steadily been declining ever since.

This week on dsma and dsma live (featuring me as a guest speaker) the focal point of the discussion was the a1c number  and its impact on diabetes management.

From dsma, here are the 101 surprising things I learned about the a1c number from fellow DOC members.

Many believe that the a1c is not an adequate measure of diabetes control.

  1. It’s a time-exposure snapshot that doesn’t adequately capture the highs and lows.
  2. Doesn’t say how happy you are with your diabetes control. Does say whether you could have better
  3. it ignores the standard deviation portion which is as critical.
  4. A1Cs view of “control” is like near-sighted tunnel vision. Doesn’t see everything, nor the whole picture
  5. it gives an idea of averages, but not overall daily care. someone w/ hi A1C may have very tight range of higher numbers
  6. HbA1c is only a partial measure; it neglects standard deviation and does not show how adequately a patient stays between the margins
  7. it makes me feel validated when it’s good BUT I hate that it also measures my self-worth as a diabetic.
  8. it’s really more a measure of how many bad/stressful days I’ve had during the previous 3-4 months.
  9. A1C’s view of “control” is like near-sighted tunnel vision. Doesn’t see everything, nor the whole picture.
  10. it is an average. I’ve had 6.1 with daily swings from 50 to 300. Need to include standard deviation as well, IMO
  11. i know for me the better my A1Cs have gotten the better control I’ve been able to get because its motivational to me
  12. Not the whole picture. It Can alert to out of range BGs you don’t catch with finger sticks, but can make wild swings look like great control.
  13. A1C is the Cliff Notes of control. 2 many other factors also need to be looked at.
  14. The A1C is a good thing to know, as frustrating as that number is sometimes, but it’s imposing and should be one of many facets.
  15. A1C is like a quarterly report card. When the grade is good, you are happy; when its bad, well,you are not so happy.
  16. A1Cs are a good snapshot for your Dr., but I know that my results have been swayed due to a lot of low BGs
  17. talk about a major guilt trip (your a1c is 12. you are going to DIE and have NO LEGS)
  18. Of course the low A1Cs are accurate and the high ones are not.
  19. not necessarily. You can have a great A1c, but numbers everywhere, and a bad one with level bgs.
  20. A1C is a measurement that I work hard to get a specific value for. Good = I feel better. So that makes it adequate for me.
  21. I don’t think so when I take into account my bgs from 40 to 400 that gave me a 7.0
  22. I’ve been below 6 but my lows were too much for me. I prefer to be in the low to mid 6s. But my last was 7.1
  23. My A1C jumped from 6.2 to 6.9 at last check. I knew it was coming, my own tracking indicated it. So it’s worth something for sure.
  24. I just think my A1C result should not be handed out on an ugly piece of photocopied paper. I want foil embossing at very least.
  25. when I have a good A1C, I feel elated, but that lasts about a day
  26. A1c should be used in conjunction with info from adequate glucose checks + consideration given to standard deviation/iron levels
  27. My A1C target is “down”. And may I say, it’s a bitch to *always* have room for improvement. Never satisfied, never good enough.
  28. My goal is 7. That’s what I’ve wanted for the last couple years. It’s where I’m going to get… dammit.
  29. My target is the whole number below where I currently am
  30. I don’t have an actual target,but I would like to be within a “normal range” to know that what I’m doing is working for me
  31. The lower my A1C, the more awful lows I experience. I’d love, love to be 7% flat and holding. More steady, less lows.
  32. I want the number that involves the least amount of yelling/eyebrow raising/dirty looks from the doctor.
  33. A1c is no longer a target for me, now that I have better tools, knowledge, and esp support. Lower std deviation is my target
  34. My target is under 7, close to 6.5 as possible with no severe low blood sugars requiring help. A work in progress!
  35. “Lower than it is” – does that count as a target? The problem with A1C’s is that lows suddenly seem appealing, just for balance.
  36. have received some conflicting advice. So, low as I can go without hypos getting too scary or rest of life vanishing.
  37. My A1C is so low that it inspired a whole bunch of street rods.
  38. I don’t understand how some people always seem to have 6.5 or lower! I can’t get mine below 7.5…that’s my record.
  39. In 8th grade I tried lying to my parents about my sugars because I thought I’d get in trouble, the A1C outed me
  40. A1C goals should be targeted for individual. Also blood pressure and cholesterol targets. Heart disease is biggest complication
  41. I don’t know… A 6% may mean you had a bunch of lows and a bunch of highs, so that’s not real control
  42. lots of lows, lots of $ for test strips, juice, being alone w/bad low=danger, etc. Its good to strive 4 it, but not in every case
  43. I had a 5.8 A1C. But it came with way too many under 30 lows. My endo & I both agreed the cost wasn’t worth the result.
  44. it’s a good goal, but if you have to have a lot of bad lows to get there, I don’t really think it’s worth it.
  45. I do not think our insulin is good enough for a stable below 6, don’t think you can do it w/o too many lows
  46. I think every PWDs goals are their choice! Diabetes is all about choice and no one should judge others decisions.
  47. I think you should strive for whatever numbers you are comfortable with. Whether that’s above or below 6% is up to you.
  48. I don’t. I think PWD should strive to attain the best control they can and the A1C will come from that.
  49. I wouldn’t ever assume what someone Else’s A1C should be. To each PWD their own moving targets.
  50. The closer we can get our A1c to “normal” levels (without high/low excursions) the less damage we let diabetes do to us
  51. I think if you can do under 6 without bad lows, that’s great. But not everyone can. Find a level that is right for you.
  52. Cuz a1D sounds Like a failing grade? …sigh… cuz it helps us stay in check when we have a goal and stuff
  53. I wouldn’t aim for sub-6, but if I were to, my priority would be on reducing deviation too.
  54. A PWD should strive for an A1C that works for them, their body, their management, their Doctor. To each their own.
  55. I think for myself at least a 6 is reasonable for many people with D but not necessary so for everyone – its right for me i feel
  56. Personally… when I was sub6, I had a lot of lows and didn’t feel safe. I feel more uncomfortable a little higher.
  57. I think everyone has to decide for themselves what goal they’re comfy with. 6.0 isn’t the “holy grail” for all.
  58. My obgyn said if want to prep for baby, get below 6. Endo said no let’s go for sub 7. Low A1c no good if you drive car into tree.
  59. Working with my CDE, we’ve determined that below 6 A1C for ME historically has meant too many lows. And I’m okay with that.
  60. I do it to get as close to a non-diabetic’s A1c as possible so I can reap their benefits, but that is just me
  61. I worry the only way to get my A1C below 6% is to suffer through way too many lows. And that scares me
  62. I think pwds should strive for the best control today and start again tomorrow.
  63. Dr. Bernstein says we should aim for 4.5 or below… that’s way too low for most PWD IMO
  64. I’m an artificial pancreas. That ain’t normal. So why should I aim for normal?
  65. I aim for sub-6 A1C. If I don’t hit it, it’s okay. That whole “If you miss the moon you still land among the stars” mentality.
  66. what we FEEL like going for_ THAT DAY. Every day is different, just as all of us are different.
  67. what I believe is that we each should go for what we’re comfortable with, what we WANT to shoot for and…
  68. The short answer is that an HbA1c should be as low as it can be … SAFELY
  69. a good a1c=whatever you’re comfortable with. And whatever wont take every second of your day trying to achieve
  70. Last endo visit I was 5.8. Basically he just said “keep doing whatever it is that you’re doing” and I was out in 15 mins
  71. we can only control what we do now… if honest with ourselves about what is going on, that will get us the best future we can have
  72. My A1c is like my golf score – lower the better, but I just sliced the crap out of that drive and it’s all downhill from there…
  73. Baby steps, This is where I am now and this is where I want to be. Not too hi, not too lo
  74. Diabetes, no matter the Type, is Not a one size fits all condition. Medical “standards” are Only a starting point.
  75. An A1C was reported in fair condition last week, after a collision at the corner of Stressful Life and Diabetes Management
  76. I like to throw a shifty A1C in there sometimes just to make sure my endo is paying attention.
  77. going on insulin has helped me get the lower A1C that and cutting out some foods from my plan that where causing issues
  78. Understanding how different foods affect bgs  differently and bolusing accordingly.
  79. In the past, good medical team support. Now? I’m just wingin’ it.
  80. Diet, medication, testing my BG’s, following my doctor’s advice, exercise…
  81. more testing, CGMS, “Think Like a Pancreas” also taught me to time my boluses more appropriately
  82. Strict attention to diet (sodium, carbs, calories, proportions, whole foods only) and exercise.
  83. Diet changes, as much exercise as I can handle, a positive attitude, and a great sense of humor.
  84. Testing — a lot! The rest is far less influential. Tell me again why insurance co’s put limits on test strip quantities?!
  85. At first, quitting my job helped b/c of less stress. But other stresses pop up in their place, you know?
  86. Working out like a crazy person to the point of breaking an elliptical has helped for sure.
  87. a food log helps me pay more attention
  88. checking the cgm 100 times a day, bolusing for anything over 100, not eating anytime near sleeping
  89. I really have just changed my eating habits and paid strict attention to carbs, and exercise. what else can I do?
  90. Oh, and my husband’s freak-out’s because he doesn’t want me to die.
  91. Watching what I eat, regular fitness program and of course checking my BGs about 8 times per day
  92. Going onto a pump-relearning diabetes after MDI for 40 years before that  I was winging it before – now my wings are unclipped
  93. For me, pump & CGM were the key. BUT I honestly don’t believe that is the key for everyone. You have to find your own magic combo.
  94. Humor, accountability, friends. Too bad medical establishment doesn’t really get that part of life with diabetes
  95. tried magic spells & sacrificing bunnies, but as it turns out, pump, CGM, BG checks & counting carbs were only things that worked
  96. The DOC got me to embrace this crazy condition, and then I got the pump and took better care of me, because my diabetes is me.
  97. i find the A1C thing weird b/c i had HORRIBLE lows but great A1C before pump. A1C went up after pump, but numbers=more even
  98. A great endo. Good friends. Concerned family. Other people with diabetes who encourage and inform. Loving 2 be in control.
  99. A pancreas that functions properly.
  100. a smaller appetite, and slower metabolism. Maybe decent health insurance
  101. For me, the DOC/DSMA has played a key role in keeping me motivated! You all rule!

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6 Comments

  1. This was really cool! Great idea for summing it all
    up!!!

  2. Thanks for this article, now i understand this whole thing better.Keep ‘em coming!!!

  3. 101, I just read them all. That was great Ronnie.. :0)

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