Regardless of whether you think this SHOULD be my goal, I am here to find out if it is possible to make any difference to my A1C based on the next 2 weeks (I have 2 weeks until my blood work).
I know the A1C is based on 3 months, but if I have a good day or a few good days I see my predictive A1C in Dexcom Clarity change, so that gives me hope.
If it is possible to make a difference in the next 2 weeks, hit me with your best tips!!
Thanks all!!
Yes, that is totally possible. Go ultra low carb for the 2 weeks and it will give you a nice initial drop. The A1C is based on 3 months as you state but it is most heavily weighted toward recent few weeks. I don’t know your A1C starting point and your goal so can’t tell you if it is realistic or not, but either way, you will get a drop.
The A1C is weighted to the last 30 days, so that makes me think you could effect the number (downwards) to some degree with tight control for 2 weeks.
Since you are using CGMS, and reviewing reports, in my opinion, the A1C test is much less important. Except when insurance or other policies use it to make evaluation/decision.
I have had 2 lab A1C tests within same week (same lab), due to 2 of my doctors ordering it. There was a .4 difference, which is just “noise”, not due to changes in my BG.
I also have RBC count on the low side of normal. During chemo, RBC was even lower, and got an A1C almost a full point lower than expected. (Did not match my CGM averages).
You may not want to do that even if possible. Lowering your A1c too fast can cause eye problems. Slower and steadier can actually be safer.
Eye problems from lowering my A1C to fast!? I wonder what qualifies as too fast? That’s terrifying…
From my personal experience, in late 1980s, I went from 11-13 A1Cs (on NPH+Reg insulin injections) to 8-9 A1C after switching to pump with Regular insulin based on carb counting. Soon after I had significant changes in vision.
Unfortunately, in 1989-1990 there were few places doing laser treatments, and the place near me had equipment failures that took 6 months to repair/reschedule my appts for several laser in both eyes.
3 months after lasers, I lost all sight in one eye, and told to wait 6 months before doing vitrectomy. (Later learned from eye surgeon that vitrectomy should have not been delayed. But this procedure is much safer today).
Anyway, at one point at least one of the doctors said lowering my A1C more slowly might have resulted in less or no damage to my eyes. But the delays and equipment problems also contributed since additional bleeding was occurring during wait.
However, my eyesight is still well enough to drive, etc, after 50+ years of diabetes, and minimal additional eye treatments except cataract removal.
I dropped my a1c from 7 to 6 in one month. Then down to 5, however I could not maintain it that low for long. I’m happy being in low 6s and it’s not that hard with a closed loop pump and cgm. My latest was 6.1.
The test itself is problematic. It’s an average of red cells being glycated. It’s not really a measurement of your sugar.
A certain percentage of red cells become glycated or glycosilated when they are created sor of giving an idea of the glucose levels when they were created.
Red cells live for 3 months so that’s where that comes from.
However if you get blood drawn while your sugar is low, your a1c will come back lower.
Also if you drink lots of water it will make your blood less concentrated which also lowers your a1c.
However ask yourself the question. Why are you trying to lower it in 2 weeks? Does your doctor shame you?
Really if that’s the case you need a new doctor.
He or she should see the real state of your diabetes so you can maybe alter your plan to get better control.
Too many doctors throw around terms like bad diabetics. I had an endo tell me that you can’t trust what a diabetic says they are eating because they lie.
Soooooo yea I never saw him again.
You are the one seeking his service. Don’t feel shame. You are where you are and, taking better control will make you feel better, so do it because you want it.
We all eat like crap sometimes. That the big we meaning everyone.
I’m no eye doc, and don’t know whether this is the definitive paper on the topic, but here is one paper that talks about changes in refractive index due to rapid changes in BG;
Stay safe!
John
Ugghhh…now I’m scared about lowering my A1C, when I thought that was a goal to strive for! I’ve never heard any harm in how fast I reach that goal! The last three months I’ve incorporated Metformin, regular exercise and lowered carbs and calories.
For refence, my recent A1C’s were:
Aug 2019: 8.9
Oct 2019: 9.1
May 2020: 10.6
Aug 2020: 9.1
Nov 2020: 9.3
With all the work I’ve been doing, I was aiming for an A1C in the 7s (even 7.9 would be totally exciting and motivating for me). My Dexcom Clarity report shows that my estimated A1C should be 7.6, which I would be so happy about. Now I’m a mix of happy and TOTALLY SCARED!!
Do you guys think that was too fast a drop??
My blood test is in 2 weeks, should I make any changes??
Very scientific, but thanks for sending…I will try to read through this tonight!
My motivation to lower is totally just that I want to see some results from all the effort I’ve been putting in, and I thought an A1C under 8 would be very motivating and rewarding. My Doctor does not shame me whatsoever, he’s wonderful and I went through a lot of doctors before finding him! Others certainly shamed me.
I haven’t been able to succeed with all that I need to do to get my numbers down until I addressed my depression, which I’ve been working on and actually getting a handle on over the last 6 months, but mostly the last three.
I think my “why” for the next 2 weeks was just a self motivator, and I was just curious how much the last 2 weeks could factor in, but now I just don’t even care about that and want to go at the right pace!!
That is so scary!! I had significant vision changes 11 years ago, but it was at Diagnosis and IDK what my A1C was anymore, but my blood sugar was 38. A few days after getting stable, my eyes blurred up and it lasted a couple months, but eventually everything went back to normal.
I wouldn’t worry too much about the eye thing. I experienced it right after dx, basically just difficulty focusing, as my BG was coming down out of the stratosphere, but never again since, and that was 37 years ago. Something about the density/pressure of the vitreous fluid due to high BG, and your eyeball takes a bit of time to adjust when it comes down. But you aren’t trying to get down from, like, 14s or whatever. You might notice something but I don’t think it’s all that worrisome.
One thing you might want to be aware of, given the numbers you report, is that you may experience a downward shift in what BG level makes you start feeling hypo. That’s pretty common—even something like 140 can feel low if your metabolism has gotten accustomed to cruising at, whatever, 300 or so. Less radically, in my bad old pre-CGM days I used to feel scary-low, knees locking up etc., below 80, and now I hardly notice unless I’m hitting low 60s.
I’m so sorry that other people have shamed you! It sounds like you’re going in a great direction, and not super fast like from 11 to 7 or something (wasn’t clear in your initial post the degree of change you were looking for), which is where I think the potentially for retinopathy comes in. As someone who has gone from in the 9s to in the 6s, over the course of a couple of years of tightening blood sugars, I relate both to having been shamed and also wanting motivation. Definitely your goal sounds good, but I would also encourage you to see any downward movement as progress, so even if you don’t hit it by this bloodwork, your Clarity etc is a good indicator that you will get there if you keep doing what you’re doing!
Thanks for your feedback! I feel better 
I’m going to discuss all of my concerns with my Endo at my appointment, which is just over 2 weeks away to make sure I’m on a safe trajectory! I won’t attempt any extremes the next 2 weeks, I’ll just keep doing what I’ve been doing (being CONSISTENT with exercise, step goals and being ACCURATE with counts (calories and carbs) and the hardest one for me which is super silly because it should be the easiest…pre-bolusing!).
Congrats on going from 9s to 6s!! That’s wonderful!
Funny, how timely… I follow a little daily motivational quote generator and the one that just literally popped up on my phone says “small changes make a HUGE difference!” how timely!
Pre-bolusing is hard! Might be worth considering either Afrezza or one of the newest even faster insulins (Fiasp or Lumjeev or however it is spelled) if you can get those covered, since they may reduce the need for prebolusing. I know from my experience Afrezza eliminates that need entirely. I had trouble getting it covered until I got in touch with one of Mannkind’s pharma reps. The co-pays are higher but for at least the first year, I got a savings card that makes them pretty reasonable.
I already have FIASP, but whenever I use it in my pump I get a swollen and painful site by the 3rd day. I was attempting to bolus with it for meals via my pen, but I felt annoyed to pay for the pump supplies and then use a pen too. Although, that is hardly the thing to worry about…whatever gives me the best control is paramount! I am making a list of Q’s for my next Endo appt., and I’ve added Afrezza to it! Thank you for the info.!
Been there!. The best advise I can give is to eat correctly. Keep your sugar as close to your goal as possible. The Dexcom Clarity report has been off about .5 from my hospital labs. It was .5 in the wrong direction. Just do the best you can and it is what it is and you will have the next months to change if u need to do so. For me, the last two weeks before the test did not do much but that is me. Good luck