The A1c is a measure of average elevatedbloodsugar. Lows do not affect the A1c.
I do not get A1c’s because no matter what the number is, I cannot achieve better control. I do the very best I can. If the number serves no real use, why have one? I will do one if the doctor will admit it’s for his benefit and not mine. Otherwise, there’s just no reason for me to have one. I am a brittle diabetic and my food, insulin and exercise do not correlate. Knowing my A1c will not change that. (I also run higher at times to prevent bouncing. My physician feels the constant up and down does more damage than a constant elevated. Of course, I keep the “high” as low as possible and still prevent bouncing.)
i think your ‘elevated’ parft begins at zero which would incur passing out or dying.
lows do count but you must remember just because you have one low it isn’t like it will wipe out a weeks worth of high blood sugars sticking your your cells.
Lows do affect A1cs in the sense that while you are low, fewer red blood cells are getting glycated. But lows usually don’t last nearly as long as highs do, so proportionately, highs affect the A1c more.
I use the A1c only as a comparison of myself to myself. Since I’ve always run A1cs in the 6’s for 18 years, when I had a 10.1, and then a 10.7 a month later last year, it was obvious I was in deep trouble, only the fool doctor never twigged, because I’m sure he’s seen higher ones than that, and didn’t notice that it was FAR out of the ordinary. So the end result was that I went into an unnecessary coma – he should have done something when he saw the 10.1, but its unusual nature never dawned on him.
The A1c is for you to evaluate how you are doing, and if it stays steady, that’s a good thing too, even if it’s higher than you’d like.
I tend to agree that it does not show the whole picture. While I am thrilled that I have managed to drop my A1C down to a 7.0 with a lot of hard work… it does not show that the stress of my job still gives me crazy highs and lows… I am thrilled to have dropped it. I just want to figure out how to eliminate the highs and lows that come with a high stress job (for some reason my body physically reacts to the stress)!
I agree that the A1C test, to me, only adds stress. I’d much rather focus on my day-to-day results, and avoid going low as well as avoiding going high. The A1C is just a number and doesn’t really represent how much your life is being effected. Good control (to me) is when I don’t have to think and worry about myself all day, just automatically do the things that make for steady results. Of course in my case I still have to FIND these things, very frustrating. But oh well!
My A1c’s have been all over the place for the last 57 years !!!
For the first part…in the 1950’s, 1960’s, 1970’s even begining 1980’s we had no testing available. I was in severe denial. I have been on the pump for the last 10 years and the CGM for a couple of years. My lowest A1c has been 6.2% and I was passing out all over the place. Now I am happy with a 7%, 8%, even 9%. I am so sick of trying to analyse all the time. All I can say is I am still walking around, working 10 hours a day and I will be 60 years old this weekend. I do not know why I am still around, how I am still around, but I do take advantages of the technology out there. There are no simple answers why your body does certain things…there are so many factors involved with Diabetes. I am just very thankful that I am still here and I do the best I can. Stressing about it doesn’t cure anything. Taking doctors words as gospel truth is not always going to work. How many doctors actually have Type1 for over 50 years ??? Nothing is text book with Diabetes. I am just glad to still be around.
Sheila
Yes, the lows are so fleeting and probably cannot cancel out a “bounce” to high after hypoglycemia. That’s a better way of explaining this. Thank you.
I agree and thank you for your comment. My measure of success has always been that I am still breathing and doing well, rather than whether I can achieve a certain number.
Happy upcoming BD Sheila 
That is interesting. I was just reading on one website from the UK that NICE (National Institute of Clinical Excellence) has decided to change the target to 7.2!
I have had exactly the same problems as you with the synthetic insulins and after a very long fight (4 years of hypoing goodness knows how many times a day) I managed to get a change to pork insulin - though my endo and diabetes nurse dropped me from their books and I was without care for nearly two years! I now have a brilliant endo in a town 45 miles away - a long bus ride x 2, but it is well worth it. I too am hypo unaware until I am LO when it all kicks in at once! And I am brittle.
Considering how iffy your chances were in the old days, it’s a miracle you’re still here! And, of course, you should do what works for you – it’s YOUR body, after all! Congratulations for having made it this far!
It seems like interpretation of the A1C is very much like interpreting a slot machine? I haven’t really gotten that much “tactical” feedback, perhaps because for years I’d hem and haw and mumble about correction boluses (which I didn’t calculate or log in any way…) and they’'d go “oh, ok you know what to do…” but there wasn’t a lot of connection. I really got the hang of it when I had a pump which, with the CareLink gizmo, logged stuff intelligibly enough that I could make strategic plans informed by tactical experiments and experiences. Maybe everybody does this but I have not really heard those sorts of words come out of doctor’s mouths too much.
What most of the world hasn’t caught on to is that A1cs mean different things for different people. Even though they try very hard, some people can’t get below 8 while others easily get into the 5’s. (And some people get into the 5’s with difficulty!)
The only use of the A1c is to compare yourself to yourself to see how you’re trending. And an unusually high A1c can be a sign of trouble, if the doc is smart enough to see it.
As far as using the A1c for diagnosis, it will miss a significant number of people and then the ADA will continue to complain about all the undiagnosed diabetics walking around.
Can you tell I’m not particularly impressed with the A1c?
Wouldn’t you know how you are trending from your daily glucose measurements? I’m confused (as you probably have figured out).
My new favorite quote from my Endo – “Well, we’ve recently found that the A1C number isnt what we thought it was.”
I’m still not 100% convinced about the glycator business b/c however you slice it (or process it?) it still measures the concentration of sugar in blood over time which seems to correlate with increased chances of complications? At the same time, I am not a doctor nor a research science and blew off biology in high school while we’re at it. I am not 100% sure that medical science has even studied items like that that much. I don’t think that anyone “easily gets into the 5s” but I think that people in the 7s and 8s and other numbers do just as much work as people in the 5s. I think that the big difference is in the tactical approach, going after each BG as a chance to win and correcting and pushing ratios until you reach the “crossover point” and are low all the time. That’s when I turn my pump back up a click and things fall into place.
I’m struggling a lot these days as I’ve had insulin availability issues and now am out of pump sensors. Largely my own fault, because I forgot to check Rx’s but, of course, it’s not as if my diagnosis is going to change or my treatment plan is going to change. I just have to yell at some insurance people and pharmacists and the doctors office a dozen times every year and then it falls into place again. “Oh well, numbers are off but I’m trying to stretch the insulin in case BCBS doesn’'t come through before the vacation and I have to experiment with pumping R…”.
It’s not “eek, my doctor, seeming to be alarmed by my last A1C now wants another one in 3 months and I have all this toxic blood”, it’s just that all the data is unplugged for two days now, some of the BG tests have been right in line but some have been a shade higher than I’d have liked. I’ll still dump the blood off for the test because I’m totally curious. They ought to put an algorithim on pumps/ CGM that would estimate your A1C based on the data. AVG BG works pretty well but when it runs up, I’ll test like every 45 minutes to make sure that I see the CB start working.
There’s a FAQ on misc.health.diabetes that shows a paper on the difference between high and low glycators.
Also, for Type 2’s in the early stages, an A1c in the 5’s is not at all hard to do, if they eat low-carb and exercise. I’m on a list called DiabetesWorld, and it’s almost all Type 2’s and they talk about A1c’s in the 5’s all the time.
I once went to Hawaii, and forgot to take along my new vial of insulin, so I ran out, and had to pump R. It wasn’t SO bad, but I didn’t have the CGM at the time, so who knows where my BG was when I wasn’t testing!
One more point: When I was about to go into my coma, my BGs were NEVER under 400 and usually in the 500’s and HI, but the estimated average BG calculations I’ve seen have all shown that my 10.7 A1c was equivalent to about 260. No frickin’ way!! No wonder my doc didn’t see that anything was wrong!
I’ve known that for 20 years!! When I was first diagnosable by today’s standards (FBG 138 and 131), I had an A1c of 4.8. And what you can deduce from that is if I tried a bit harder, I shouldn’t have any trouble getting into the 5’s, although I certainly don’t have the insulin production I had then!
This high and low glycator reminds me of when we switched from urine testing to meters. It became apparent quite quickly that the level at which a diabetic spilled sugar in urine varied dramatically from one diabetic to the other. My urine sugars were “clear” when my actual blood sugar was 300. It’s interesting that the same type idea may explain the A1c differences.
"I don’t think that anyone “easily gets into the 5s” but I think that people in the 7s and 8s and other numbers do just as much work as people in the 5s. I think that the big difference is in the tactical approach, going after each BG as a chance to win and correcting and pushing ratios until you reach the “crossover point” and are low all the time. That’s when I turn my pump back up a click and things fall into place."
I would actually be very curious about what the difference is between people who are able to achieve 5s and those of us who struggle just to achieve low 7s (or, in my case, get back out of the 8s). Maybe something to start a discussion on … It does seem to me that some people, for whatever reason, are able to hit the 5s and 6s relatively easily and/or can maintain steady BGs that fall into easily-identifiable patterns, while others struggle just to get into the 6s or 7s and stay there, and/or seem to have more random numbers. Maybe something to start a discussion on …