@Mila How about adding:
Tunneling- Infusion site failure caused by insulin tunneling back to the skin’s surface along the cannula.
Or something like that.
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My C-Peptide is 0.21. My kidney function tests are all perfectly normal at this time.
Adding to S_Woodward’s post about A1C, I’d suggest adding that A1C can give an inexpensive and immediate assessment of the patient’s overall glucose control over the past 2-3 months, but if Continuous Glucose Monitors are possible, Time in Range (TIR) is now considered a better indicator of glucose management. For sure I would at least remove the word “best” from the current definition.
Based on current knowledge I’d completely revise the definition of the A1C and re-categorize it as a fast but crude diagnostic tool.
It’s a bad metric except to say someone’s BG is high enough that they MIGHT have some form of diabetes (which needs to be confirmed by a tolerance test. )
The A1C is useless for management which is about making effective decisions not about giving general advice.
With an uncertainty error of 0.5 , and no indication of highs, lows or statistical deviation, it barely qualifies as a meaningful metric.
A1C, like pretty much all diabetic data, has some value. The actual number, as you mention, is not critical as it can vary by .5% between labs and also with places that do not use certified equipment. When a person is first tested, it does not matter if they are at 4.2% or 4.7%, as they are not diabetic in that range. If their first test, however, comes out at 7.8% or 8.5%, they are diabetic. So this has validity in the first tranch. After that, the trend is essential. If they test every 1-2 years and the A1C remains low, then no problem. If it is a diabetic range, a goal can be set for food, exercise, and medications to improve the A1C over a set period of time. There are so many variables that most people just need to know if they are improving or getting worse. The A1C does that.
Those that want to take a more proactive approach and perhaps micromanage their diabetes come to a forum like this for help and use more extensive tools to keep themselves in even better control.
As technologies improve, A1C will become moot, but we are not quite there yet.
The A1c is useful for diagnosis in combination with other tests.
Beyond that it’s a metric of limited utility.
A1c is not useful for managing diabetes because you can only make a poor therapy decision based upon its value. You can’t prescribe or convince people to make specific lifestyle changes when there’s no direct correlation with a lab test.
Even when A1c is combined with a fasting glucose value and a typical BGM log, clinical decisions about how to meet the ADA and AACE targets carry a certain risk of hypoglycemia.
Those targets were set high 30 years ago to get the risks of hypo and complications down to a level acceptable to doctors, not to maximize quality of life for PWD, based on the tech available during the DCCT.
The tech to get better management data via CGM has been available and practical for more than 20 years, almost a decade longer than the iphone. Both were from US based companies. Virtually every doctor in the US uses a smartphone, and consider it an indispensable business tool, but only a small percentage of their patients WD use CGMs to preserve their health. How is that not doing harm?
Trying to meet A1c targets while using BGM and experiencing more hypo imo is the most likely reason that less than 1/4 of US PWD meet those targets today.
The A1c isn’t the best tool available and a defacto standard that is a human generation out of date and has limited practical clinical application shouldn’t be considered “gold” today. And the old targets are conservative, negligent, if using the 20 year old tech.
That is in the published consensus report of an international committee of endocrinologists.
Nothing in diabetes management is yet infallible, which is why we use multiple results from various pieces of hardware to compare trends from one to the other and make sure all our results balance out between the different trends. CGM beats finger sticks but we still use finger sticks when we know our CGM is way out of range to get an idea of how far out of range the CGM is on, let’s say, day one of insertion. We use GMI, TIR, BG, AGP, and A1C trends to make sure we are on the right track for managing our blood glucose. When we have all those trends in a happy place, we then need to follow our APOb as insulin causes the inflammation that causes the plaque in our main arteries, killing a large segment of the diabetic population. So yes, diabetes management goes way beyond A1C, as controlling blood sugar without controlling cholesterol and atherosclerosis at the same time is not a prescription for a long healthy life.
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