Hey guys, type 1 of 17 years here. My A1C levels have always ranged from 6.0-7.5 (9 times out of 10, and other times not drastically above or below)
Of course, my doctor (who is also a type 1) tells me GREAT! In fact, go a bit higher when I’m at 6.3…
I don’t have any complications currently, except I take a statin and blood pressure meds (though I dispute this because my BP is always normal when I take it out of the office AND I have 17 inch biceps that could cause it go read high at the docs office lol)
I just feel like I have hurt myself over time with these numbers. I have no eye problems, no kidney issues, etc…but I think about heart health down the road.
I’d like to bring things down to say 5.7…but have I totally screwed myself over time to this point by following the typical guidelines of “shoot for 6.5 or 7%”? I got T1 when I was 10…now I’m 27.
I have been a PWD for 42 years. At times my A1c has topped 12 and at times less than 5.5. I have spent most of my D life about 10 and and a few years in the 6’s. So what does it say> We don’t know. Nor can you. We know that those who have higher blood sugar tend to have more issues. That doesn’t mean those with lower blood sugar will absolutely have less complications or those who have higher will have more.
you might expect from my discussion that I am beset with complications. Yet i am not. I certainly have nuropathy and i have background retionopathy The eye issue is so minor the it comes and goes.
So am i perfect? Nope, do i wish I had taken better care of myself? yes, can i change one thing int he past, no. My best advice, stop worrying and do the best you can going forward.
i wish you the very best. I really do. But please know this you have not wasted your chance. Unless of course you let this destroy you by over thinking it. If that happens, of course any thing is possible. Tuck it in and do the best you can.
You can’t worry about things that you’ve done in the past, only what you can do in the future. I don’t think you would be at very high risk of complications with that tight control, but even with the tightest control, the risk is never zero. If you can get even lower, then that’s great, go for it. But you can’t worry about what can’t be changed.
I was diagnosed with Type 1 when I was 9 and have had it for over 24 years now with no complications. I always had pretty tight control (for the '90s), but did go about five years in the early '00s where my A1c was in the 8% range. Like you, I do find myself worrying at times about things like heart disease, knowing that by the time I’m older I’ll have had diabetes for many decades. But I try not to worry for long. All we can do is the best we can do at the time with the tools that we have.
I say if you’d like to shoot for a lower A1c, go for it. But do it with your eyes wide open. I wouldn’t do it without using a CGM because otherwise you’re flying blind. The reason doctors freak out with patients with low A1c’s is because without reducing blood glucose variability, a low A1c (<6%) almost always means an increase in hypoglycemia.
Do you know what the statistical measure “standard deviation” is? Standard deviation is a measure of how much your blood glucose swings up and down. About 2/3 of your time is spent within +/- 1 standard deviation from you blood glucose average. If your standard deviation is 60 mg/dl and your average BG is 110 mg/dl, then 2/3 of your time will be spent between 50 mg/dl and 170 mg/dl. You’re scraping the bottom of the BG barrel here!
What if you could tame your BG variability to a standard deviation of 30 mg/dl with the same 110 mg/dl average? That would put you between 80-140 mg/dl for 2/3 of the time, a much better and safer situation.
So my long answer to your short question is if you want to enjoy a lower A1c then you need to concentrate on BG variability if you want to do this safely. Doing it without a CGM is difficult, in my opinion.
In the end, lowering your A1c will not absolutely decrease the incidence of diabetes complication but it will reduce the risk of those complications. Not only that, but I think you will be better off not only physically but emotionally as well.
Go for it but get a CGM and reduce your BG variability before you start reducing your average BG.
Sure, go for it! As far as I can tell, you’ve been doing fairly well, and I would not worry about the past. Looking forward, you can further reduce chances of complications by tightening your bg control some more. Depending on access and personal preferences, there are different approaches you may want to pursue - there are good books, and many posts here on TuD and elsewhere - do some research, and feel free to ask more specific questions. A good step would be to get a CGM.
Tony works awesomely hard (as we all do to the best of what we are able in the moment!) cycles a lot and eats very low carb. He’s a wonderful person and role model!
I understand the feeling of wanting to “catch up” on your BG control after periods of not being in great control. But it doesn’t really work that way…the bottom line is our pancreases are broken, so give yourself a break and realize that some fluctuations in BG are unavoidable. You can keep tightening, but that also means you will have very low quality of life. Maintaining BG’s of <6 requires a very rigid lifestyle that not many people are willing to endure. However, <6.5 is usually achievable and yields good longevity results, but still allows some flexibility. Genetics play a part in this too, because we’ve all heard from people who have had T1 for 50+ years since the “dark days” of no BG testing and they are still complication-free, and conversely people who have done pretty well for 10 years and are having eye or kidney problems. I don’t think you have screwed yourself at all by staying under 7, that’s actually really excellent. So put your focus more on staying under 160 as much as possible, and stabilizing any spikes you see a pattern with. If you don’t already, try bolusing 10-15 minutes before eating, that can help too. Other than that, you can only do your best and continue to live your life. It’s great that you exercise regularly, because that does a lot for keeping your BG in a normal range.
“Flow” by Mihaly Csikszentmihalyi suggetsts that human happiness can be found in engaged activity, trying to do something better as opposed to simply “good”. I learned this through Tae Kwon Do, at the same time I acquired an insulin pump and it made sense to keep pushing to improve rather than “lay up” at a more moderate BG target. I don’t like the suggestion that I’ve heard some doctors have told some of us that “your A1C is too low” as that doesn’t make any sense. It’s the individual hypo that will get you, not your A1C!! I’d keep at it and see what you can do!!
As far as worrying about the past is concerned, it’s pointless. First, as has been pointed out above, there are no guarantees of anything in the world of diabetes. Moderately high BGs do not guarantee complications near term, nor do relatively low BGs provide assurance that there won’t be any. It is to some degree a crap shoot. The only policy that makes sense—physically or mentally—is to focus on what you can control, i.e., what you’re doing now.
You can’t fix yesterday.
There’s nothing wrong with shooting for a lower A1c if you go about it intelligently. Plenty of good suggestions above, I won’t waste space repeating them.
For the record, I keep my A1c in the mid fives and hypos are quite rare. It’s eminently doable if you’re willing to do the work.
I was dx with T1D four years ago at age 49. I had an A1C over 13 and already had peripheral neuropathy and minor kidney damage. I must have been sick for a long time. Well, that freaked me out. I went very low carb, exercised daily and tested a lot. No pump, no cgm - I have no interest. My first A1C was 5.8 and have been in the mid fives ever since.
I started with buying the books “Using Insulin” by Walsh and “Think Like a Pancreas” by Scheider. Both are my lifelines. I learned so much - they shouldn’t let us go home with an insulin rx without them. Get your basal right first, then go forward from there.
Over time I gave added in more healthy carbs as I’ve gotten better at this. I still don’t eat white bread, pasta or white potatoes. I replace the French fries with a salad (I steal a couple from my dining partner) or a small portion of sweet potato fries (yum!) and no buns on the hamburger or hot dogs. It’s not so bad - and much easier now. I messed up my knee, so now I only walk 3 miles a day and do strength training a few times a week.
I find that with lower carbs and testing a lot I have few lows. I think, and this is just my opinion (and experience), lows are more frequent with more carbs - just more chance of getting it wrong with more carbs/more insulin. I used to write down everything - you’d be surprised how often we eat the same things. I have been making very interesting veggies lately - I don’t get bored.
There’s no telling what happened in the past, as everyone said just look out for the present. Do your best and when things don’t go well, try to do better tomorrow.
This is what Bernstein calls the “Laws of Small Numbers”. Point being, the less insulin you need to use, the less chance of a serious mistake or imbalance.
I agree wholeheartedly with CSB 49. I also had complications when I was diagnosed (neuropathy and retinopathy) as well as an a1c of 12.3. I got that down to 5.7 in less than four months (a little too fast as I found out) and have never been over 5.6 in the last five years.
Here is my take on my a1c. Our bodies are supposed to have a BG between 70 and 100. Anything over 100 is not normal (normal being nondiabetic). The higher your blood sugar number the more inflammatory your blood becomes. This causes inflammation of everything that your blood touches. It weakens the blood vessels and eats you alive. I do not know where the line it’s. At what point is high blood sugar safe? No one seems to have that answer. So my answer is anything over normal. That being said it is definitely a tricky target to hit. Our A1c is an average. If your average is between six and seven than on average your blood sugar is well above normal. Those of you who have not experienced serious complications may have a more relaxed view of this. Personally I don’t feel that I can afford to let my guard down. I like having vision. I like being able to tie my shoes, take a walk and keep all my limbs.
Since diagnosis I have spent, easily, well over a quarter million dollars to retain my vision. I actually do see better now (in most ways) than I did at first. But, I am still legally blind. I cannot tell you how many PWD I have talked with who tell me there Dr. is happy with an A1c between six and seven. Then they say they have done everything he has told them to as well. So they are surprised now that their fingers are turning numb and their vision is blurry (even if it comes and goes).
We all do what we need to do to take care of ourselves based on what we know about our disease and body. Personally, and I mean this with all respect, I do not understand settling for a blood sugar level that is potentially killing me, when I have all the control over the situation. I truly believe that by understanding more and controlling my disease tightly I am a better patient for all my medical team.
I still have all of my complications but, they have all improved over the last five years. My retinogist tells me that I would not be where I am and his treatments would not have been as successful had I allowed my A1c to run above the normal range. And really, that’s all I need to know.
Nice going, Randy5. Yes, they should warn us, especially with retinopathy, that bringing our blood sugars suddenly down to “normal” can cause its own issues. I’m sorry it’s progressed so far so quickly. I show slight signs - some blame on my quick reduction of A1C. You and I both understand that we probably couldn’t do it slower. We stay under 100. That’s just the way it is. It sort of confuses me too when most of us don’t. It’s hard, but we do.
My doctor gives me a hard time and then downloaded my meter - very few lows. The only dangerous one was when my husband tested a mojito (which I didn’t know until I asked him when I got home). Yup, he makes sure my exotic drinks are low carb. He has no idea how great he is. Turns out mojitos made with stevia aren’t bad, and low carb! We both drink them and it’s how we serve them to guests. No complaints yet.
Everyone can have more “normal” blood sugars. But you have to know how. Get the books.
Thanks, sometimes it just helps to get the support.
