Earlier in the week I had my endocrinologist appointment. Before heading there, I uploaded my BG readings from my meters to Diasend. (Dr. K likes looking at actual readings as opposed to Dexcom trend data. That job is for my CDE.) (And I heart Diasend by the way!) Printing out results from the past 30 days confirmed my already existing suspicions that I’ve been encountering a few too many high BG than I’d like. And as usual with me, there were no obvious patterns but more random, various times of day or night when they have been occurring. With my print outs tucked inside my bag, on my way to the office, my nerves grew. Although my average BG from the meters reflected 143 mg/dL, which I know isn’t terrible, I knew the high BGs would elevate my A1c. And I got really nervous that my A1c was going to be the highest it’s been in a while.
Nope. The same as 3 months ago. I’m currently holding steady at 7.2. For once I was very happy with that number. Last time I was satisfied. This time, actually happy. That it wasn’t higher of course. For the life of me I cannot figure out how the A1c works. Most of the time I anticipate lower than the results I get. This time I expected higher. And I was still wrong. When I was growing up I had my share of high A1c results. 9’s, 10’s, even higher. Those were a result of control standards not as tight (in the first years of my diabetes life) and later, not controlling it like I should. However in the past few years that I have been putting a lot of effort into my diabetes “management”, my A1c has always seemed to fail me at giving a precise picture of what my BG is actually doing. I know not to rely completely on BG readings to give the whole picture. There are many hours in between that can have BG swings. But in the past 3 years since I’ve been using the Dexcom system, knowing what my BG is 24/7, it still doesn’t always tie into my A1c. It wouldn’t bother me so much except for the fact that so much weight is put on this test. Every person in the medical field wants to know what a diabetic’s A1c is. My endo and CDE assess my management success with this number. The ADA and AACE predict how this number will affect my chances of complications. I’m all for managing BG as best as can be – obviously I want to be healthy now and for years to come. But this stupid test not only gives me anxiety every 3 months, it doesn’t even make sense. At least for me.
image credit: sodahead.com
Recently I mentioned in a post that I have been testing my BG 17-19 times on some days. I am trying to “control” my BG like never before but those frequent tests do not have all to do with my efforts. I can thank many of those tests for the lack of confidence I have in my glucose meter readings. A few months ago I blogged about frustration I was having with my One Touch meter, leading me to switch my primary meter to the Freestyle Lite. Since then, I have used the Ping meter on occasion since
I am lazy it is convenient to be able to bolus from that, especially when I wear a dress or skirt and the pump is tucked away. Also on occasion, I have continued my comparison between the two meters. Here is where things take a turn. When I conducted my “testing” between meters back a few months ago, the Freestyle was ALWAYS higher. And I mean always. Now in recent weeks, every time I do a comparison, the Freestyle is ALWAYS lower. And I mean always. (Except when I encountered a meter reading fantasy and the meters read the exact same!) This is so perplexing.
I was so sure that since using One Touch, I was not getting a1c results I expected since it was reading lower than my actual BG readings. Now, I’m not so sure. I don’t know what to think most times when I test my BG. All I want is a reading that will help me manage my diabetes and let me make the right decisions that my health and life depend on. All I want is information I can work with to get my a1c below 7%. How am I supposed to do that if I’m not even sure what my BG really is? Can the FDA or a diabetes meter company answer that for me?
Thank goodness for Edgepark allowing a split shipment of test strips between different kinds. I’m not sure what I would be doing if I didn’t have that option.
Yesterday I had my quarterly appointment with my endocrinologist. (I’ve never referred to it as quarterly before but since it occurs every 3 months or 4 times a year, I guess it qualifies as a quarterly event!) For some reason I was unusually calm beforehand. Well maybe except for those very few minutes before she entered the exam room. I went without any BG readings for her to review, thanks to my recent meter switch, and felt very guilty. And still, my 128/75 blood pressure reading reflected my calmness. (side note: my BP is always higher than that due to my nervousness) We went over all things diabetes related and all seems well. I have a Nerve Conduction Velocity test scheduled in 3 weeks but that’s another story.
One of the reasons I dread my endo appointments each time is not due to the dr herself. Or the office. It’s simply the a1c. Since I have been putting forth a much greater effort into my diabetes management, my a1c readings have weighed greatly on me. My result yesterday was 7.0%. Down from 7.2% three months ago. Dr. K is pleased with that and considers it good control. Since using the Dexcom CGMS continuously (no pun intended!) over the past two years, my a1c has remained pretty stable around the 7.0% mark. It is the lowest level I have ever had in my 29+ years of living with diabetes. And while I’m satisfied with this value, I need to work on it a little more to try and it get it a tad lower. To a value that I’m actually happy with. Satisfied is good. Happy is even better.
(photo credit goes to Yoshikazu Nagai)
For those of us who have been living with diabetes for a long time, we know how much things have changed in regard to its treatment. I was diagnosed in 1981 when things were quite, quite different. At the very beginning, I didn’t test my blood glucose. At all. And it wasn’t because I was being “non compliant”, it was because we didn’t have a glucose meter. The method of testing glucose levels at that time was with urine. I also didn’t take multiple daily injections throughout the day. It was probably one or two, split up between morning and evening. And as much as we know that things are not like that anymore, I came across something recently that reminded me of just that. My mother came across this book that they had gotten for me, pretty soon after diagnosis.
It’s a workbook explaining diabetes in terms that are understandable to a child. There were some fill in the blanks/Q & A’s that I had completed, God knows when, that was interesting to see. But what really blew me away was reading this:
“Most persons with diabetes should attempt to get values in the range of 10%“. WHAT??!? Did I read that correctly? The advice to people with diabetes was to aim for an average blood sugar of around 240?! So all those years when my a1c was exactly that, around 10%, I was considered doing good? I assume that the different guidelines for controlling diabetes today, came from research. And more of it. And the advanced technology introduced from said research. But to see this in writing, even so many years after my father’s generation of those living with diabetes, astounds me. No wonder diabetes was once seen as a death sentence. No wonder complications were inevitable. No wonder the quality of life for living with diabetes was left to be desired. I have to say that I am glad I am in the time now where the aim of a1c is 7% or lower. I am glad I am in the time where I have the ability to monitor my glucose levels continuously with the help of a monitor. I am glad I am in the time where I can control my insulin delivery more easily with an insulin pump. And the times of diabetes are going to contiunue to change. And for that, I’m very thankful.
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.