Hello all, I am a type 1 diabetic of almost `14 years (diagnosed at 10, 23 years old) and was wondering about the idea of misleading A1cs.
I will start by saying that as of right now, I suffer no complications, fortunately.
My A1c’s from ages 9-19 were low 6’s to mid 7s most of the time, with the rare 8 misstep. From 19-22 they were mid 7s on average, and the last two years I have been in 6 and 7.
I will say that for most of my diabetic life, lows have not been a significant problem (in other words, anything lower than my blood sugar at 50 I could count on my fingers.)
My last A1C was 6.5 (which my endo said might actually be too tight control, which is odd, not to mention he says I do better than 90% of diabetics my age with a 7 a1c.)
6.5 is say, a 150 for all intents and purposes. Would that mean that a truly misleading A1C would be my sugar at 50 half of the time, and 250 half the time? I am just a bit concerned, because I don’t have drastic lows very much, but I don’t want to be damaging my body. When i have hypo signs or I test and my sugar is high, I immediately correct for it.
I don’t think A1c is a good indicator of overall control in many cases. When you test, what kind of range are your BGs usually in…or are you all over the place?
Also, some people are high or low glycators (search; you’ll find info on this here on TuD) and this can affect an A1c’s level.
This is something I agree w/ Dr. Bernstein on, although he has a different way of getting there than I do, in that my goal is to have my BG as normal as possible. It’s not always attainable but I like having a lower goal than I can attain so I can have something to shoot for, although I just had a tremendous disappointment in a run by overestimating my capabilities by a longshot.
See the problem with the “or are you all over the place” is that alot of the times when i test, it is because I have a symptom of high or low blood sugar. Therefore, once I take meds or eat to correct this reading, and my sugar is fine for hours afterward.
IMHO? You might think he was a nut if you only read the front and back covers of the book or just followed the press releases. In reality his books have a lot of breadth and depth and even if you can’t achieve his A1C of 4.0 I think there are good tips in the book that will help with bg control and maybe a little more too.
I think he is a nut because of the Swedish crackers but I think that his methodology is very sound. If your goal is 140 and you miss 1/2 the time, your A1C might pass muster but if your goal i 85 and you miss 1/2 the time, 1/2 of your misses are still going to run int he 95-120 range which is still pretty good. I totally agree that you can hit that more easily with very low carbohydrate approaches however I am determined to hit it with moderate carbs. Including beer and junk food. heh heh heh…
He has a lot of very interesting things in his book about various science things (large shots, etc…) that are very useful to have read.
A1Cs are just A1Cs. I have to admit that I brag on mine (come on! after 50 years with D, I should be able to show some pride in my control! Want to talk about control at 16 in 1968 with Lente and later NPH?)
What counts is the hour to hour control. Highs and lows mediate to a great A1C, but not a great life. Watch the readings. If you have a lot of lows (some high BGs) and average an A1C of 5-6, beware. Is it good? I like to sleep and work and go to school as a rational human being. Lows are HARD.
I use my Endo ONLY for scrip refills. Not diabetic/does not know all the “ropes.”
Endos use A1Cs a lot. They are (usually) not diabetic, so it is our jobb to educate them
I guess then you’d need to make an effort to test more often in between those times where you have symptoms? What if you tested once every 1-2 hours one day? You’d get a better idea of where your BG is for extended periods of time.
I am a low glycator. I was diagnosable by modern standards with 2 separate lab fasting BGs of 138 and 131 taken 3 months apart. But my A1c was 4.8. That was in the beginning, when I had pretty good insulin production; it has declined over the years. Last year, I was depressed, and binged for months on lovely refined carbs like angel food cake (I still hate the person who has an angel-food cake as his avatar, LOL!) and although I was taking insulin, it wasn’t enough, and I ran my BGs into the 400-600-HI range. Not for a day or a week, but a couple of months. And my A1c was 10.7 upon admission to the hospital. I looked up the eAG (estimated average glucose) for that A1c, and it was somewhere in the mid 200’s. Like, NO FRICKIN’ WAY!! My (former) endo totally missed the diagnosis 6 days before I went into the coma, because my A1c in the lab was 10.1, my fasting BG was 302, and my brain was too addled to be able to tell him I was in deep doo-doo. Last week at Diabetes Sisters, a woman gave a talk, and said that when she was diagnosed, she was just not feeling well, and her A1c was in the 19’s. And here I was, almost dead at 10.7!
There is an article on differences in glycation among people with the same average BGs on the misc.health.diabetes archive. It’s a relatively old article, and no one seems to have noticed it. And in other news, I just saw a report on a study on adult Arabs mentioned on the site Diabetes In Control, aimed at medical professionals, and it showed that people who were definitely diabetic by other measures, like fasting glucose and the oral glucose tolerance test, had an AVERAGE A1c of 5.9%, which means that many of them were below that. And would not have been diagnosed if an A1c of 6.5 were the sole criterion for diagnosis. The pre-diabetics had an average A1c of 5.1, which the current medical establishment sees as totally normal. What gives?
I interpret that paper to mean that my part-Semitic heritage has given me the genes for low glycation, but this is only a little dip in the pond. What about people of other ethnic heritage?
But to address your other question, being a low glycator means that I don’t have perfect BGs by any means, but after 20 years with the D, I don’t have any complications. The medical establishment hasn’t even acknowledged our existence, apart from people who have certain hemoglobin variants. Of course, there are no studies on whether being a low glycator protects you from complications, but you are case #2 in my very limited study! I totally believe that you don’t have many extreme excursions – some Type 1’s DO maintain enough insulin production to modulate their BGs, but I also think there is more to it than that. I am very interested in the results of the Joslin study of the 50 year medalists, to find out why they lived so long, and mostly complication free when they were diagnosed in the Paleolithic era of diabetes treatment. I don’t know whether they are considering the difference between low glycators and high glycators – I don’t even know if they are aware it exists, but you can tell this is one of my soapboxes!
I don’t know if it is even possible to know the average BG, because you would have to be hooked up to an accurate monitor for weeks, and I don’t think that is feasible. The medical folks like the A1c because it is easy to measure and less hassle for insurance companies, because they don’t have to pay for the multiple blood draws required by the OGTT, and the patient because it doesn’t require fasting and staying at the lab for hours, and they have exactly NO idea how inaccurate it is. I am so adamantly opposed to using the A1c for diagnosis, because of my own experience, and the Arab study just confirms it. Not that anyone is listening to me!
He may be a nut to some, but makes a lot of really good points, grounded in science. I don’t apply his approach to the letter but do apply his principles.
IMO rather than A1C or average BG, the important piece is standard deviation and average BG. My goals are more towards shrinking my SD than improving my A1C, though they’ve gone hand-in-hand. My BG goal is 90; my last monthly average was 102, my SD 24, which I’m pleased with. Still more work to do though!
the standard deviation issue is interesting. My latest A1C averaged me at 153…so that means I could be half the time at 200 and half at 100, or half at 180 nd half at 130, or half at 250 and half at 50 (certainly not the case). I guess all we can do is try to correct our highs and watch out for lows as best we can.
My old endo told me to keep things between 100 and 200…after 13 years ive now for awhile been trying to keep it as close to 100 as possible when not at work (i unload trucks, my sugar goes low sometimes, got to keep it slightly high to compensate at times)
A1C is a blunt measurement tool, as is your “average” BG reading from your meter. You and your endo should be using these, plus everything else about you to create a picture of how you are doing. How is your health otherwise?
If your A1C is relatively good (which it is) and your overall health is good, then keep on doing what you are doing. Too much focus on the numbers can lead you astray.
I’m not real clear on how to use the SD. When I print out the Carelink reports, my SD varies widely from day to day. I’m not sure what, if anything, to do about that. Help?
One day is really not important, it’s a week, or a month that counts for me. My Diasend (Ping) reports will give me my SD over whatever period of time I choose. My target bg is 90, so a SD of 24 means I’m mostly between 66 and 114 (yes, a little low at the low end, but mostly during the night so no biggie). The lower the SD, the closer I am, on average, to my target bg. So working towards lowering the SD with a reasonable target bg makes more sense to me than working towards a lower A1C, though they will go hand in hand. Does that help or make you more confused? LOL
Yesman, the standard deviation actually has to do with the jump factor not the average. If you go from 30 to 300 every day, you will have a higher standard deviation than if you hang out at 120 every day and stay fairly stable. You might drop & bounce high every morning then stay stable for the rest of the day and have a fairly decent average but a higher standard deviation . The reason to look at the standard deviation is because the jumping around is just as bad as staying high all the time.
Natalie, I am like Jrtup and worry more about the weekly & monthly ones instead of the daily ones. I do look at the individual days to try and figure out where I went wrong. It is kind of like looking at your BS – you aren’t going to beat yourself up over one bad BS, you might look at it to see what you can do differently.
I totally believe that you don’t have many extreme excursions – some Type 1’s DO maintain enough insulin production to modulate their BGs, but I also think there is more to it than that. I am very interested in the results of the Joslin study of the 50 year medalists, to find out why they lived so long, and mostly complication free when they were diagnosed in the Paleolithic era of diabetes treatment. I don’t know whether they are considering the difference between low glycators and high glycators – I don’t even know if they are aware it exists, but you can tell this is one of my soapboxes!