Doctor said A1C is too low for a Type 1

I went to my doctor and my A1C was 6.0. My doctor said that is way too low for a Type 1 and made adjustments on my pump. Honestly I was excited to see a number that low. My lowest was earlier in the year at 6.9. I guess part of it is that I have had at least several lows a week. I did have a bad low one time though that didn’t register on my Dexcom. I know that I need to work on the lows but I’m just tired of running too high.

In my little twisted part of the world, your A1c is only too low when you run the risk of hypos. Have you been having regular hypos? That is the real question. Every visit with my doctor, we have the same discussion. I have to "prove" each time that I have not been having lows.

ps. Perhaps your doctor is also worried that if your A1c get's too low, you won't have diabetes anymore and they will have to take your pump away. ROFL.

I agree with Brian. If you are not having lows, it's not an issue. But you did mention that you are having them regularly and have had a really bad one.So may less tight control is not a bad idea.

If you don't mind my asking, given the dexcom and modern blood glucose monitors, why aren't you adjusting your settings yourself? Get the book "Pumping Insulin". This is not rocket science and you will have a better feel for your own body than the doc will. Especially when it comes to temp basal rates for things like exercise.

Have to agree with Brian. If you aren't having a lot of hypos, then your A1C is fine, excellent and something to be desired.

Did your doctor have a knee-jerk reaction to a great result, or did you have a more in-depth discussion?

FWIW, I have a lot of fluctuations as well (I am sure they aren't hormone related, though). I frequently change my basal rates, most often with temporary basal settings, like this week when I have been fighting a cold and therefore have been less active.

For me, there is no pattern, which means I have to rely on my own intelligence and meter readings to bring some amount of control to my numbers.

me too, no pattern it seems. fluctuates all the time. can do the same thing, eat the same thing every day and different results. it's called type 1 diabetes, like driving a care blindly with no breaks, no accelerator, no steering wheel. this is the definition of type 1 diabetes.

I think your doctor is being cautious because of the lows. Quite basically she is looking out for your immediate health and not looking at your long term health. You said you were overdue for a visit with the doctor, maybe she is concerned you might not come back for a while again ? If you download your pump at all then you have the pump settings so you can change it back if you start to run high.

I have fought this forever. MY A1C ranges between 5.1 and 5.8 (for 8-9 years) and I get **** about it all the time from my PCP and ENDO. Long story, but I need to be comfortable. After 51 days of "adjusting" I am no longer having the lows, but I am still struggling with the higher numbers--132 to 260--it is not my comfort zone and I freaked when the endo said he would "not correct for a glucose reading of 252."

After lots of reflection, I need to do what makes ME work. I am just afraid he will rate me as "non compliant" and refuse to update scrips. That is a huge burden to bear.

I run a shade lower than that and have never had a doctor touch my pump. I have lower numbers pretty frequently but the vast majority of them are "drift" lows like oozing towards the 60s, if lunch is coming and the rate of change is slow and nothing's going on, I might wait 15 minutes and just take a low bolus for lunch rather than get all crazy treating it. I still have "crash" lows occasionally,I think that it's an occupational hazard of diabetes. Did the doc look at the "pie charts" to pinpoint a timeframe to cut back? I might accept that but would be very suspicious of an across the board, let's turn *everything* down approach. I feel pretty strongly that aiming at more normalized BG (lower than rx'ed by ADA/ AADE...) can help prevent lows but you have to be really engaged with your diabetes (which you must be, 6.0 seems like an excellent result?), test a lot and watch your data to make sure that you are on top of spots where you get a lot of lows. It also helps to be on top of carb counting. If I have some lows with guesstimated food, I'll measure a meal in that timeframe precisely to get a more solid carb count and see if how a bolus does. I think that any problem can be solved and am not a huge fan of docs saying "your A1C is too low, let's turn your pump down so you run higher." You can fix lows without running high. It's challenging but that's what I try to do. Of course,I'm not a doctor, I'm a goofball named AcidRock23 on the internet so it may not be prudent to listen to me.

I would see another doctor. Another option would be to give up the pump so you can take better control of your sugar.

How does getting rid of a pump= better control? I saw improvements with a pump and more improvements w/ a CGM. I understand that some people do very well with MDI but I also like that I spend less time dealing with diabetes so I have more time to do other activities whether it's running, reading or debauchery since I've got a pump.

Agreed. I have gone through a similar battle with not only the doctor but the nurses fighting me because I had an opinion that challenged theirs. They dismissed me from their facility which was the biggest blessing in disguise. My current endo is extremely flexible. We work well as a team and that’s how it should be.

I am in the "strive to have labs as close to a person without D" school of practice. I did get some grief when I moved to a new city from the endo, but my Dexcom4 showed that I handled the trend arrows well and that I am just a***-retentive about my D. As someone above suggested, get John Walsh's Pumping Insulin (59th Edition I think now). That and Gary Scheiner's Think Like a Pancreas can make you very able to adjust your pump settings. I usually change a little, wait three days and change again if necessary.You cvan get both books at Walsh's website, The Diabetes Mall.

As an additional comment: Someimtes I think MD's resent when their patients with D either know more than they do, or are successful. Say8ing things like "I'll take away your pump" (i have fewer lows with the pump by the way) or threatening people with type 2 with insulin - don't the docs know type 2 is progressive? I've had knowledgable freinds with type 2 have to beg to get rx'd insulin.

I am.

What frightens me is the non-compliance issue. I am seeing a new endo and I hope her thoughts are different... But if I have no one to write pump scrips (my PCP won't do it,) I am up a creek.... I go low a lot--most of the time I am OK, but sometimes not. My brain is not as good as in the past,

I just yearn to be "normal." Never happen, but I can still dream.

My doctor has said for years that my A1c is to low, It runs from 5.0 to 5.7 and two minuets later he is checking my feet and says your neuropathy is worse. So where does one go from there, I have had excellent numbers most of my Bete's life and I'm still showing signs of complications. At times I even patted myself on the back saying...I'm doing so good, I'm going to retire in good health, and then I was diagnosed with Cancer (HCC) at 59 and told I had 12 to 18 months whiteout a liver transplant.

We really have little control over how things are going to work out, do the best you can to balance your life, live healthy, take care of your family and friends, don't put things off, If you have a it now, worship the Lord He is always a kind and careing God.

My A1c does not define my life...and it will never be part of the legacy I leave behind...;-)

I don't think 6 is too low at all, my endo said you should be at 6 to avoid complications. If you're having severe lows yes, then I would run higher though. I have the same problems as you and I agree with Sarah, it's called type 1 diabetes. I have unexplained fluctuations and changes frequently. When I'm sick my bg will usually go higher, so I assume I may be fighting off a bug then. I had the flu and pnemomia shot wednesday, th had a fever, aching, nauseous etc. and had to stay home. My bg spiked twice, the first time it went rapidly to 165 from 60- I ate one candy to treat that. the other was several hours after dinner, I spiked to 200(really high for me) with no real reason. It took corrections and exercise/housework to get me back down and then I went hypo for an hour and had to eat /drink juice before I felt safe to sleep.

"I freaked when the endo said he would "not correct for a glucose reading of 252."

Does your endo have D? I doubt there are many people who wouldn't correct at 252!

Search "non compliance" on the site. When I first read posts I was shocked. When my endo told me "Another A1C of 5.1 and you will be out the door.." Except his threat, it has not yet happened to me, but it is a huge heavy club when wielded by someone that important (scrips) to my health. Scared me...a lot.

And, it seems non-compliance is a huge issue. It has to do with insurance and measurements of the doctor's success. Too msny who don't do well--it causes problems with payments, etc.