How Good is a Good A1c?

Over the years my a1c was never “good”.  I remember around my teen years it was around 10, probably higher at times.  There were reasons it was that high but I’m not going to get into that now.

When I started on the pump 3+ years ago and began religiously counting carbs I noticed a big difference in my bg readings.  Not that I didn’t have any highs or lows but there were less of them and less big fluctuations.  Yet every time I went to my endo and had an a1c done it was still always in the 7’s , sometimes at the high end of 7.  A lot of my appointments ended with me in tears because I was actually working so hard on managing my bg yet my a1c wasn’t a reflection of my hard work.  I never really got an answer from Dr. R on why I wasn’t getting results I expected.  She told me that it was like math – you can have a B average by getting all B’s or by getting A’s and C’s.  That kind of made sense but wasn’t comforting at all.  I had a CGM but used it only now & then, when I wanted to get some trends.  Then last summer I started using my CGM on a regular basis and here it is over a year later and I haven’t been longer than maybe a day without it.  My last a1c done by my endo’s office was 6.8 in June.  I had finally gotten an a1c under 7.  After 28 years!  I’ve also invested in some of the Bayer A1c Now Selfcheck kits to get an idea where I am in between endo vists.  I took one of those tests on the same day as my last endo visit and got the same exact result.  I’m not saying they are 100% accurate but that comparison increased my confidence in them.  A lot.  I took another self test last week and could not believe my eyes.

Could it really be that it was my lowest a1c ever?  Even if it was off by a little bit that would still mean that I am running in the low 6’s.  Still the best I’ve ever had.  I personally believe the CGM has a lot to do with the improvement of my bg management.  But I’ve also been having a lot of lows in recent weeks.  And I believe that is a big reason for the lower a1c.  Although I am extremely pleased with a 6.0, I’m not extremely pleased that it means I’m having many lows.  So is there a line between an a1c that is within recommended levels and one that is the result of too many hypoglycemic episodes?  Is it okay for me to have a recommended a1c even if it means I’m having low blood glucose levels once or more per day?  We all know that a lower a1c means less of a chance of complications right?  But how low should that number really be?  I think this is something I’m going to be discussing with my new endo in a couple of weeks.

6 thoughts on “How Good is a Good A1c?

  1. I have long wished that they could measure the amount of fluctuation our BG levels have, instead of an average number. Someone who pings between 50 and 200 equally gets the same results as someone who consistently hovers around 125. The A1C just doesn’t always reflect the hard work we put into it, which is unfortunate.

    But, congrats on the lowered A1C! 🙂 Imperfect as the grading system may be, it still feels good to see results like that.

  2. I think that the A1c test (1 data point — or 5, if you do a couple of Bayer kits’ worth at home between endo visits) is less indicative than the CGM log (thousands upon thousands of data points. I have been led to understand that the problem is as much the fluctuations as it is the averages, and that while the “180’s” and the “40’s” may average out, the issue is that there *are* 180’s and there *are* 40’s. The other side to that coin is that this is variability often part of the very nature of T1DM.

  3. It depends on what you mean by a low. Ive known some people who think anything below 90 is a low. I’ve met some T1s who see anything above 80 as a high. In the end it all depends on what your goals are. Long term diabetes management calls for a low A1C. For me that means I try to keep my pre-meal BG under 80 and 2HR post meal BG near 100. I don’t consider myself low until my BG goes under 60. My A1C ranges from 5.5 to 6.2.

  4. I think that your “low” should be what’s comfortable for you. My endo constantly tells me that I need to keep my A1c where it’s at (6.5). I would like to get it lower. I’d like to be in the low 6’s or even the high 5’s. But I think it depends on the number of highs and lows you really have. If you are not having a lot of major highs or lows then where you’re at should be fine.

  5. You go girlie. That is a tough one. An issue I have dwelled on many times. They always say the lower your a1c is the more likely you are to go low. Just do your best. That’s all you can do. Congrats on the 6! 🙂

  6. I agree with Cara – I think it’s kind of an individual thing. What ever you are happy with and what ever works for you. As I type this, I’m low and I’m feeling it – so I hope it makes sense. I also had an endo appt today, and although my A1C has risen by .3, we are both thrilled because I had been having so many low lows in the past.

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