Meeting with sister diabetics, we were discussing A1C’s and daily testing. Some swore by their A1C and others were more careful with their daily testing as a sign of how they are doing treating their diabetes. Here is a thought my philbotinist gave me. When you test at any time, the blood stream is like a river, and you grab a small drop or a vile of the blood that is moving through the stream at that moment. You test that small sample and get a number. It it’s an A1C you get some remnants of what you had in your system for three months…trace amounts. When you test everyday, you get a small sign of what you have done over the course of a day. One gives you a small sample of your treatment the other gives you a sample of your day, and averaged together…gives you a sign of how you have done over a week, a month, etc. So which tells you best how you are treating this disease ? I would say the daily testing would give you a better pic and the A1C is a controlled atmosphere for the docs. So what do you think? I am trying to make sense of this, not to skip an A1C but to get a better idea of where I am going with my treatment
i think they are both useful. Not a great answer but testing involves more than just a test, if you test once, it’s great but if you test again 45 minutes or an hour later and the number’s different, it can mean other things and it can mean things if it’s the same too? A1C gets sort of bashed a lot. One thing that I think is kind of odd about it is that I think that you can ‘cook’ it by having lower BG when you drop it off for the A1C?
I trust daily testing MUCH more than an A1C. You can ‘score’ well on an A1C but have terrible control - such as huge peaks and horrible lows. Daily testing will show you what’s really happening. What you want is a good average bg with as little standard deviation as possible.
A1C is a convenient way for medical staff to get a glimpse of what’s going on. They don’t want to look at weeks and weeks of complicated logs, plus, you can cheat on logs. Really doc, I only ate 1 piece of pie…
For me, I find that the daily glucose readings are an indicator of how you need to act there and then, in the moment to balance your levels and diabetic control to the best of your ability. The A1C is more helpful to your doctor to show your average levels, and your control (hopefully progression!) that you are making throughout the year. It also acts as a motivator (at times!) as a number which shows you how hard you might have been working towards controlling your levels and being in optimal health. I find the daily levels more important myself, as they are the ones that I have to work with on a daily basis, to feel well and to allow myself to get on with everyday life. If my levels are sky high, and I go to the gym or take a correction shot, and later that day the number has decreased to the ‘normal’ range, I know that I am treating my disease in the best way that I can, in that moment. So for me, the everyday testing tells me best, as I live with this daily, and I can try my best to control my levels daily : ) Sorry if that was slightly repetitive!!
All the answers were pretty true to what I believe, As you said Julie, you can’t cook the Daily scores, but the A1C is pretty easy to slide by on…been there done it. But daily, it’s right there in front of me, and I have to take it.
Since I have gotten my daily numbers under control again, I see a pattern and know what I have to do. An A1C, I truly believe is just the docs way of getting one number, but not the entire picture, it’s a corner of the picture. not what I do on a daily basis to take care of me.
But I suppose there are those who would say they all work together and I suppose they do, but I’ll trust my dailies a lot more.
Interesting replies by everyone! Maybe to me the BG tests are “battles” and the A1C is the “war”? There are quite a few posts sort os suggesting that A1Cs suck but, at the same time, I sort of like knowing a big picture. When I tried to lose weight very unscientifically at the same time I started working out a ton, my A1C hitting the 7s was a big motivator to get a pump.
Edited to note that I just noticed that this was posted in the T2 forum. I think the A1C might be a lot more useful for a T2 because their bg is (generally) a bit stabler than a T1…
Interesting, I didn’t know what the A1C actually measured. I wonder if some people score better on an A1C than others because maybe their cell lifespan is shorter, or their red blood cells don’t get glycated as easily?
I have a wonderful A1C and have never had a problem maintaining it. I am not a ‘good diabetic’ though. I eat what I want (which normally involves lots of junk food and candy). I do test a lot, and correct a lot - but I see the mountains and valleys on my CGM and I know that my standard deviation during the daytime is sometimes terrible. Even when I was taking 40mg prednisone per day for several weeks, and frequently seeing high 200’s and even 300’s, my A1C stayed below 5.5. Makes me not trust the A1C at all.
I’m one of the people that don’t glycate very much, and you may be too. My A1c has always been lower than what my testing numbers would indicate. When I was first diagnosable by today’s standards, with lab FBGs of 138 and 131, my A1c was 4.8. When I got very symptomatic, and was consistently over 200 for months, my A1c was 7.1. And when I went into a life-threatening coma last year after 6 months of BGs in the 400 - 600 range (I was majorly depressed, and bingeing on carbs and sometimes omitting insulin), my A1c was 10.7.
So I regard it only as a comparison with myself – I know I should be in the low 5’s if I’m doing a good job. It doesn’t matter what the doc thinks – I’m the one who’s in control of my diabetes. And I respect the fact that other people struggle to get A1cs in the 6’s and 7’s – I just got lucky in that department. And, apparently, so did you! 
Is there a test that indicates that you don’t glycate much or is it a gut feel based on your numbers? This is a big deal because some insurance companies won’t give you a CGM or pump unless your A1C is above a certain percentage.
There is no test that I know of. Many doctors don’t even know about it, but there is a paper on misc.health.diabetes about it. I figured out that I was a low glycator by doing a lot of testing and comparing what the chart SAID my average BG should be, and what it really was. Some sites now give an estimated average glucose based on the A1c – those that give a range are more in tune with the reality of the situation than those that give a single number.
And yes, you’re right, it IS a big deal, because the insurance companies are run by people who really don’t know the facts about the A1c. It’s a good measure for population studies, but crappy for individuals. My (former) endo completely missed the fact that I was in trouble a week before I went into the coma, because my A1c was “only” 10.7.
I’m lucky that I got my pump and CGM without needing to prove anything. Just a letter of medical necessity. A lot of other people are not so lucky.
The upside of this, though, is that if your other tissues don’t glycate easily either, you may not be prone to complications!
I trust my daily testing to keep me on track. A1C is an average over 3 months. One A1C for me was 5.9 and doc was thrilled, but that test was full of highs and lows, it was not good. I shoot for 6.5 because it is best for me, not so many lows which I find to be emotionally and physically draining.
This is a debate among people who are guessing. a1C provides an approximate average for the past 90 days, heavily weighted to the past 30. It’s simple and among the cheapest lab tests to perform, doesn’t require fasting and can’t be gamed (in other words, if you eat nothing for 24 hours before test, won’t change the result measurably). BG on the other hand provides a snapshot at the second it is taken. An a1C of 5.0 equates to an average BG of 100 over the past 90 days. However, a 5.0 would also be the result if you spent 4 hours a day at 150 and 4 hours a day at 50. The former is a dangerous level leading to complications and the latter a dangerous level hypo (for most, not all). I am lucky, my a1C, BG finger sticks and CGM all result in roughly the same level meaning that I am not experiencing significant highs or lows. But, that is not true for all and that is why every unbiased study and recommendation checklist suggests both a1C and finger sticks (before & after meals).
For me, asking this question is like asking me what’s a better tool to have in my toolbox, a hammer or a screwdriver?
It just depends on the situation.
In other words, it depends on what type of information you want, but like tools in a toolbox, you want as many sources of information as possible. Hopefully, all the tests I do compliment each other and give me a more complete picture of my overall control.
Any test can be gamed to a certain extent. If you’re not catching all of your highs and lows, maybe you test 2 hours after a meal when your BG has lready dropped to normal instead of 30 minutes to an hour after a meal to catch your peak, then your standard deviation is being gamed. Standard deviation is just a measure of variation and it’s only as good as the data set the calculation comes from, if it’s even applicable to a single individual person’s blood glucose readings.
I would say testing multiple times a day. Testing is for us to see how we are doing throughout the day, and A1C is for the doc to see how we did over the 1 month-3month period. Testing numbers are a little for the doctor, but its mainly for you, to see if you can or should correct right then and there.
Hope you get this, I’m a T2 and was recently (Jan.) diagnosised with an enlarged spleen and a growth on my left adrenal gland. I am in a holding mode with my Dr. now, but he told me before the wait and see, I was producing too many young red cells and after further testing, tells me some the cells are sickle in shape. My A1C? dropped from a 9 to 6 in three months, I was also counting carbs and watching what I ate. Could this new blood thing have helped to lower my A1C? My Dr. thinks it was excercise, I have not excercise since my son died Feb., so I just looked at him funny and wondered what planet he was from. I eat, work, cry and sleep. I like testing before I eat so I know how to eat. Dr. want test 2 hrs. after I eat. I am testing all the time. Any ideas?
So sorry to hear of the loss of your son. 
You have your plate more than full. I admire you for how hard you are working to get things in order. Frequent testing is a must if you want to keep your BGs in line – and although it’s a nuisance, at least you know where you are. Good luck!
I’m so sorry about your son. And yes, blood abnormalities can certainly affect your A1c. There are cases of people having anemia with blood sugars in the 300-500 mg/dl range and an A1c of 4%. You should trust your meter. And while you can test before you eat to get an idea of how well your fasting numbers are, it is really the 2hrs after a meal reading that gives you feedback on whether your blood sugar is going too high. If your blood sugar is over 200 mg/dl at 2hrs regularly it is basically impossible for you to have an A1c of 6%.
If your doctor remains unconvinced of problems with the A1c, I can provide references of papers discussing these problems.
I wasn’t diagnosed for a long time due to a normal A1C. One day a random doctor at a walkin clinic decided to run a fasting blood glucose test and my glucose issues were uncovered. My most recent A1C was 5.1, normal. Yet one day this month I had bgs of 66 and 266 in the same day. Albeit the high number was the result of eating candy to see what would happen but 266 is a value a normal person wiIl not see. Doctors kept looking at my A1C and telling me,‘Your symptoms shouldn’t be as bad as they are’. Look at my meter doc. I am concerned recent reliance exclusively on A1C could lead to a lot of other missed diagnoses and unnecessary damage.
You’re like me – a low glycator. Before I was diagnosed, I had lab fasting BG values of 138 and 3 months later, 131. Today, it would be diagnosable. But my A1c was 4.8. Last year, I went into a hyperglycemic coma, and my BGs were ranging from 400-600-HI, but my A1c was 10.7. I know people who have had A1cs of 12, 13, 14 or more, and were still walking and talking, but I was literally near death with liver failure, kidney failure and extreme dehydration. So I really don’t trust the A1c but do pay attention to daily BG trends.
My fastings were just like yours. Thank goodness for the walkin clinic doctor who wouldn’t let it rest and suggested we look further. Unfortunately prior to dx, thanks to the low A1C, I think my doctors just thought I was a liar. Prior to your comments in this thread I’d never heard the term ‘low glycator’. Thanks for that. I’ve read anemia can cause artificially low A1Cs too.