Hi all, So I had my A1c checked Friday and it was a great number for me (6.7 down from 7.3 3 mos prior), but I feel like I can’t even be happy about it b/c I know some persistant lows during the last 2-3 weeks before the test contributed to it. My thoughts are: so does that good A1c even count? Ugh. Frustrating.
Sure it counts! Give yourself credit for achieving that reduction in your A1C! Then after you do that you can look at the bigger picture. If you had a lot of lows then yes, it might pull down your A1C. People in previous discussions have actually given formulas as to what portion of what time period contributes to the A1C; I don’t remember it exactly, but I do know the more recent weeks are higher weight. So that means you have some fine-tuning to do to see what you can do to avoid those lows (question doses of insulin, first basal and then bolus, find a pattern of what causes the lows and when they occur to see if you can reduce them and/or catch them sooner, etc). But even if you know you need fine-tuning, don’t throw out your good work entirely!
I have been wondering about this as well. I am regularly going through some bad lows that seem to occur immediately after I get my period. Won’t these throw off the accuracy of my A1C? I think my endo prefers more to look at my logs so that she can see trends and the “true” numbers, but I know the A1C is heavily relied upon as a way to track overall progress. It just seems that maybe it’s not the best way to track progress, because if you’re swinging between 40 and 300, it’s not going to acurately reflect how you’re doing.
I have also read that more than an A1C, it is the rage with which your blood sugar fluctuates that has more to do with the development of complications. So, if you’re consistently at 170-200, it might be better than shooting for a low A1C and causing lots of highs and lows.
Just something I’ve been thinking about a lot lately…
I agree about the damage of extreme fluctuations, DogLady, but I wouldn’t settle for being consistently at 170-200 because that is where damage and complications can accumulate. I think doctors tend to advise that type of approach because they have been programmed to tell us to avoid dangerous lows and because the ADA still advises 180 as a reasonable post prandial goal!
I think that’s a bad advice… even a the age of 8 (when I was diagnosed) I was told that ~180 is the “renal threshold”, which means that it marks the point at which your kidney can’t hold the glucose back anymore.
(It is individual, therefore it varies, but 180 is what they tell you)
So, a constant - however good a constant bg might be - bg of 170-200 should not be considered “good”! In the long run, it most definitely affects the kidney.
Back to topic:
Sometimes I think that, too. Since I wake up <100, it kind of makes me worry that my daytime bg might be worse than I think it is. I can see my A1c only as an average number of my bg of the past 3 month, not as a number to be happy about. If my bg was at this level all the time, it would be great, but for half the time, its somewhere above or under and swinging around.
Actually, that’s why I set it as my new goal to avoid (bigger) fluctuations.
But the A1c counts… knowing it is still important and it also gives a first impression on how you are doing.
Ok, so I did a little math. If you had continued to maintain the same level of control as your last A1c (7.3%), but just had some nasty lows in the last 2-3 weeks, that would have required to be 70-110 mg/dl lower than usual. That is some serious persistent lows. I agree with Zoe, you should give yourself some credit.
Thanks everyone. I am working to get the lows under control, but of course I want it fixed “yesterday.” Haha. I’ll try to give myself a little credit. Even w/o the last couple of weeks, I’d have to think the A1c would’ve still been somewhat lower, if only just a bit. Thanks again!
I would count it. I run low pretty regularly. I only get interested in the one that are like in the 40s.
A1C is nice but it isn’t a complete picture by itself. If the lows don’t totally get in the way, they can still be a bother so yo may want to make an adjustment but only if its happening a lot. If the results are off at the same time, in response to the same carbs for like 3 days in a row, I’d think about making a change. If it’s just “oops, I miscounted the carbs” then just count file under your experience for next time. Once a pump is set (which 6.7 would indicate to me…) it’s just a matter of fine tuning the settings. I like to do this one meal at a time, sort of experiment with the settings just around a meal and see if you can get it tighter, both not too high and not too low, for that meal, rather than adjusting every goal, particularly up to 170-200? Great job on the improvement though!
Thanks for the advice acid! Wouldn’t you know that after two weeks of crazy lows and adjustments I’ve had two days of extreme highs…wtf? Pretty sure it’s hormonal though, so now I’ve got yet another trend to keep an eye on. I’ll tell you what: Diabetes is certainly not the stuff for people who hate documenting/lists and routines 
Haha. Okay, it’s official: I’m gonna count this one and give myself a mini pat on the back. Thx again.
That’s where I use the pump charts, rather than actually keeping track of stuff. The “hourly” reports (I think, I’m not 100% sure which one is which…) will give you an average by time of day and, while my schedule is not always the same, sometimes it will suggest “hmm, this number is off…” and I’ll try the ratio at that time and see what happens, look at the “meal”(time) prior to the time in question too maybe and see what I can do with it. I refuse to log anything other than what the gizmo does. If you had enough data to compile a conclusion that there were hormones involved you’d probably have a choice about how to approach that?
Choice? Sure. Try to adjust dosages. Trying to figure out how to dose for normal female hormonal fluctuations on a monthly basis where there is absolutely no consistency, well that is another story! Apparently my pump charts aren’t extensive enough to get things stable for me, so looks like I will have to be logging information daily for some time, but if it can help stabilize, then, well, I’ll just have to force myself to do so!