agreed. My doc has warned me that good A1c results can be had by having lots of lows. Those lows will mask the A1c-raising reality that comes from spiking and/or spending a lot of time with high bgs. My own experience with A1c results that I expected to come out higher than usual, but didn’t, bears out what he has told me.
I’ve been puzzled over the last few years why my meter and CGM numbers predict an A1c below 5.5% while I consistently range from 6.0% to 6.4% A1c. In another thread I discussed this meter/A1c disagreement but I’m happy to read that you also understand this weakness of the A1c measurement. A convenience for docs, indeed.
I’ve decided that the gold standard measurement is the CGM time-in-range number. A high percentage of time in range incorporates reduced variability, time spent hypo hypo, and a good average BG. I shoot for 80% time in range.
I enjoy reading your comments!
Longer than normal lifespan for red blood cells raises A1c, and it is possible that lower bg will increase that lifespan.
Plus one study found that people whose A1c was higher than predicted were usually that way consistently on future tests.
I’m always higher than expected, but I have heard the same from quite a few people who go for tight control. That’s fine with me, though. If my A1c was 5.2%, my doctors would probably take away all my prescriptions.
I started on Afrezza for the carb part of my mealtime dose back in March. I continued to use my pump for my basal needs and also for an extended bolus that I dose for every meal to cover the protein and fat portion of my meal. I did that for a month and concluded that I had better control with my rapid acting analog insulin-only regimen.
But I decided to continue to use Afrezza to help bring down high BGs. I use a combination of Afrezza and an intramuscular injection to share the task, about a 50/50 calculation. It is an awesome 1-2 punch to quickly bring down BGs without the danger of overshooting. Here’s a CGM trace from earlier this month:
red line = 65 mg/dl, yellow line = 140 mg/dl
My BG peaked at 204 mg/dl at 6:35 a.m. At 6:40 a.m. I inhaled one 4 unit cartridge of Afrezza followed by a 1.5 unit IM shot in the arm. Within 90 minutes I was under 140 mg/dl and I bottomed out at 87 at the 3.5 hour mark.
I’ve done this several times. I will continue to use Afrezza for highs; it’s amazing.
1 Like
Jenny thank you for this informative post. I just staerted levemir and am nly on 13Units and had visions of ever increasing doses. I went from 7.3 to 9.3A1c and have been type II for ten years now.
3 months later my A1C is down to 6.0. (I had to tweek my dosage to avoid those morning lows.) Still working on better control (mostly my diet), but quite pleased with my move to insulin.
3 Likes