In Elementary School I learned that living beings are constantly changing. And diabetes have confirmed that fact.

Recently I decided to buy a device to measure my A1C values at home. I started using it right after returning from a work trip and I got a 7.1% value, which if not the best result is not that bad either (considering my last year’s values were around 8.5%).

Feeling happy with my results, I went to a lab to have “professionally” made tests as my insurance company recommended (I will refer to insurance companies in a different post) and the results I got were of 7.8%. So I thought “maybe this is not the best lab”, still trusting the results the AC measuring device gave me at home, and decided to confirm them in a better known hospital. Their results: 8.3%. Almost devastating.

My insurance company considered these results too high (obviously) and I had an extra charge on the bill, of course.
Disappointment. About the device? About the labs? About living with diabetes?

Once you accept diabetes as a condition that will live with you for the rest of your life and overcome your initial depression, you stop asking yourself "why?" and decide to start acting on that:

This involves several things:

  • Learning how to eat
  • Learning how to count what you eat
  • Learning to calibrate your oral medication, for those with T2; or your insulin, for those with T1. And not, I'm not forgetting about LADA: You need to learn both.
  • Learning how to understand your values. Because reading them is something anyone can do, but understanding them is a whole different thing!
  • Learning how to exercise
  • Learning to listen to your body

So, you try to do everything "by the book" and suddenly, when you look at your results you discover this ugly number. A number that means nothing to most of the people, but means so many things to you. And for some reason one of these things is crying louder: you have failed. And you are the only one to be blamed: you must have done anything wrong

You are disappointed at yourself. You feel you didn't do everything as well as you thought. You are not the expert on diabetes that you, and your family and friends think you are. And you feel guilty. Guilty about not knowing how to handle your condition. Guilty about not doing your homework.

But the reality is that this is not true at all. Or at least in an absolute way. The reality is that a 6.5 A1C doesn't tell that someone is the best diabetic patient, and a 8.5 A1C that someone is the worst.

The truth is that all the six bullets I mention above start with the word "learn". The truth is your body is not an static and immutable element. Neither is your diabetes.

And taking care of your diabetes doesn't involve learning a recipe and follow the steps. Taking care of diabetes is mostly about learning, observing, taking notes and adapting. Knowing how to interpret the signals your body gives and adjust the right things at the right time.

There's no reason to be disappointed or feel guilty when your results fall outside the expected limits. That doesn't necessarily means you failed. It just means that everything changes, the same way you learned at school and is time for, again, learn and adapt.

7 or 8 i wish mine 6 weeks ago was 11 now my reading are 100s no higher then 199 at the days end and im learing dont let it get that highmy reading changed from 400500 sometimes id wake up with 250 ive changed evrything i eat is very low carbs and no sugar no fat unless its from chicken and turkey or salmon its a lot of thinking and learning about my body but i think i finally got it figured out

Thanks! I really needed that! I’ve been feeling guilty and slacking and giving up because of the feeling of hopelessness… But you are exactly right!

ill have t0 b00kmark this f0r when i (inevitably) have an a1c result that is rubbish! thanks!

Sounds like you have a really good attitude. You know that your BG runs too high, and will take intelligent steps to improve it. This is the best we can do. In case you're interested; it is little discussed, but A1c tests are notoriously non-standard and can be inaccurate. They are useful in giving you a general idea, but far from a gold standard. Your BG at time of test has an impact on A1c readings.

We live in a very analog world. Nothing can be exact, in terms of absolute measurements. But measure we do, and we gain from these measurements. We build great things, we keep the chaos in line and we control the factors of our lives to the best of our abilities.

A1c results may not be the do-all/end-all, but it's the best we've got. And it does come close enough. Most Doctors realize this, usually reacting to changes or extremes in results. I've had A1c readings from as low as 4.6 to as high as 10.8 during my 40 years as a Type 1. Recently I struggled with keeping a 7, watching them climb steadily over time. Which is the main reason I just started using a pump. My A1c numbers were moving, and made me think more about them.

Best thing to know about A1c is what it really is. When glucose is in the blood stream it attaches itself (glycates) to the red blood cells, or hemoglobin. The HbA1c test is a measurement of how much this has occured. The more the glucose is around, the more it glycates to the cells. So no matter what your BG readings are, the A1c can be somewhat, if not quite different depending on a lot of factors that are not as easily traced.

With that in consideration, I prefer not to label a diabetic "best" or "worst", as I've been on both ends of that spectrum. Diabetes in itself is the "worst" and only "worst". Everything that can be done about it beyond that is gratis. Consider yourself lucky that you can even do something. I think about it as not about how much, any more than it is about how and why. If your personal goals bring you to a 5% A1c (basically perfect), or an 8% A1c then you've achieved that goal. These goals are not always a goal we think about either. But more deeper goals that come from our combined efforts toward our life both internal and those we keep at the top of our thoughts. If your A1c numbers make you think, then maybe it's time for action. It was for me too.

Thanks for a great post Rui!

The thing that I learned when I got my pump is that very small increments, in either ratios or rates, will make a big difference in the outcome. If things get even a little bit "off", my numbers go all over the place pretty quickly. I don't think lot of doctors or, in turn, patients re able to perceive this and get frustrated because they don't think "hmm, my BG is high every day after lunch, maybe I should crank the sucker up?" which has worked ok for me. I'm not quite "normal" BG wise but have gotten decently close.

I also don't ever think "I made the goal, I'm done...". I am trying to beat every single test by having it be where I want it to be. Not high, not low, where I want it to be. If I "miss", I don't beat myself up, I try to look at it as a good opportunity to do the best job I can fixing it. Maybe it's nuts but I sort of feel ok psychologically about diabetes and my life. Raising a 13 year old is challenging and my job can be quite stressful but diabetes is sort of a "subset"?