A1C Target Range


#1

I always thought – keep your A1C under 7 was where the bar was set. Today the nurse practitioner said things are changing and they want under 6.5 (mine was 6.5 by the way). Last time (when I was at 5) the doc said he would prefer not so many lows and so I adjusted. Are there now new norm levels?? What’s my target range supposed to be?? I think higher than 5 and lower than 6.5 is a narrow walk to walk. Yikes! What is everyone else following?? I’m a T2, insulin dependent. Thanks y’all for your input as always.


#2

My endo likes me to stay around 6.5. She has told me when it drops to 6 she worries that I’m having too many lows.


#3

Ya, things are achanging. The HbA1c range has always been 7.0 or less for us over here also, as far back as I was noticing. Most of the Drs. seemed okay with that, lower even better. That range works for People who tolerate higher blood sugars more easily.

I honestly don’t recall any of my Lab test ranges stating 6.5 or less. But looking back at my test results from the past year, the new HbA1c range is: 0.048 - 0.060(meaning 4.8 - 6.0 ). I was pretty disgusted when I saw that. That can be dangerous and stressful to Diabetics who want to “fit in” and keep their Drs. Happy. I don’t actually think our Drs. set the range. More like a global agreement between a set number of countries, governments perhaps, etc.

My last A1c in April was 0.053(5.3) but I am normally 0.064(6.4) and 0.063(6.3). For me, an A1c of 6.5 - 5.7 is Fine in my books.
I also noticed that 3 years ago we used to get a copy of 6 sheets of paper with our test results and a clear explanation of everything. Now it’'s one sheet with no explanation. Mind you, I’ve been getting them done at the Hospital instead of at the Lab that is closer. I’m Glad that I know what 99% of the ranges, initials and results mean. I’m all for saving trees but geez…


#4

“Higher than 5” being part of the target… that’s funny :-). I have been in the 5’s (and may be again) but cannot possibly imagine a 4-point-something.

Contrary to what Dr. B says, most non-diabetics have A1C’s above 5 His goal - 4.2% - is below 99% of the non-diabetics. Wow.

I agree that “setting the bar high” and aiming for tight control is a good thing. But tight control is so much more than A1C. In many of the DCCT follow-on studies (Kilpatrick et al) there is a good argument that while A1C is correlated with average bg, that really it’s the average bg we want to bring down, not the A1C.

And the correlation between A1C and average bg is actually not that good. For example, an average bg of 180 can correspond to an A1C anywhere between 6% and 10%. See e.g.
http://jcp.bmjjournals.com/content/61/9/977.abstract


#5

i read that American Association of Clinical Endocrinologists has recently lowered their recommendation to 6.0 or lower.


#6

What Alan said. :slight_smile:


#7

Oh, I also want to add that if you look at lab ranges for what a “normal” is, you may set yourself up for disappointment because these are ranges used to help diagnose people who are having problems with their blood sugar… If anyone can get their A1C as low as one can, without severe and frequent hypos, than that’s what’s good for them. It’s not necessarily the most do or die target for us, regardless of whoever wrote a fancy book might say. Yes, “normal” is ideal and perfect… but who lives in an ideal world most of their lives? It is better to have daily control of our blood sugars, and not worry so much about the A1C like someone else posted.


#8

I am type 2 and I have been lucky my last A1C was 5.5 and the one before that was 5.9. I have had major changes in my eye prescriptions to the good. I have never been above 6.9. I am on Lantus 38units and novolog usually less than 10 units a day. I do low carb/no carb if I can see significant changes in my eye sight what other improvements am I not seeing. I will be 64 this Saturday


#9

The problem is A1c. A1c doesn’t show lows or how erratic blood sugars. You want your bg’s to be below 140 and above 75 but since you can’t test throughout the day, you have an A1c to give you a general idea of how you’re doing. If you are consistently seeing good blood numbers, you should be fine.


#10

For me, the catch of the A1C is it can be very misleading. If you’re on a roller coaster of many lows and some big highs, you can get a skewed result. My plan is to keep things on an even keel daily, and if I’m happy with my A1C, knowing it comes from more consisent numbers, awesome. But if I’m all over the place and have an “acceptable” A1C, it’s a false celebration. I was a 5 once, just after my 1st child was born. My blood sugars were consistently between 35-80. It was painful, but worth it for my daughter. My next 2 pregnancies were never that low, it was just too uncomfortable for me to live with numbers that low, especially when I had a little person to take care of.

It is so easy for non diabetics to tell a diabetic what they “should” be doing. It’s a daily struggle and sometimes, I don’t feel like dealing with it.

If you’re happy with your numbers, the stick with what you’re doing.


#11

Thank you everyone for your input – to answer Alan yes, I have gastroparesis. I’m sure that is why my endo doesn’t like me at 5. Usually I’m, between 5 and 6 so maybe that’s where the comment came from - 6.5 is high for me. Most of the comments make me feel that I’m ok – I keep my daily numbers in the 70-120 range and try to wrap my head around eating with gastroparesis to prevent middle of the night and afternoon low (yesterday I dipped to 48 - oops).

Your comments help me feel I’m on target. thanks.


#12

I’ve read in a few places that an A1C of between 4.5 and 4.7 is normal… there’s no way i could do that!

I aim for below 6.5 as long as i can keep my BG from hitting the floor too much. Lately i’ve been really happy with my BG, usually 80 before i eat, then it goes up to roughly 110 an hour after eating, by two hours it’s at 100ish, and then by three hours back down to 80. (and i FINALLY got the lows sorted out :D)


#13

I added CGM (Dexcom G5 with an Android phone, no Dexcom receiver) to my Multiple Daily Injections routine 1 1/2 years ago. Have been considering an insulin pump but A1C has dropped from 7.5-7.8 before Continuous Glucose Monitoring to 6.5 with. I don’t mind mind the pen insulin injections. I can’t find any firm evidence that the switch to a pump would be of much benefit for me. I am 68 years old and insulin dependent for 43 years now. CGM was a life changer :+1:. The Dexcom G5 app audible alerts for high, low, and rapidly changing blood glucose levels are invaluable and potential life savers.