Type 1 A1c's

Type 1 and LADA
21

I think this guidance really varies depending on the individual and the doctor. I’ve had endos tell me that I should be in the 6s, but I have rarely been able to get that low. My current endo is fine with me being in the 7s and wants me to aim for that. She feels that any lower would result in too many lows, and since I have struggled with periods of hypo unawareness in the past, she doesn’t want to risk those lows. Also, for people who already have some degree of retinopathy, a sudden DECREASE in their A1C can make the retiopathy worse (cruel irony, IMO). Also, some endos I’ve met with feel that for T1s, wide fluctuations in BGs (i.e., going from 40 to 250) cause more damage than slightly high BGs (i.e., in the 150s). I think the evidence on this is inconclusive, but it does warrant consideration. I know when I fluctuate widely, I feel like crap, but if I stay a little high and consistent, I feel better.

The problem is that consensus for what actually causes complications among T1 diabetics has not completely been reached. My endo says that she has seen patients with horrible A1Cs seem to escape every possible complication, while she has patients with excellent A1Cs who have quite a few complications. While maintaining a “good” A1C can help reduce the liklihood of complications, doing so doesn’t totally eliminate the risk of developing them. There are possibly other aspects of the disease’s etiology (such as the lack of c-peptide or amylin production) that are playing just as significant a role in complication development.

22

Actually, I reduced the amount of lows by going from 6.8 to 5.5!

I’m recently experiencing too many again but not because I’m desperately trying to keep my A1C low, and I’m working on that problem.

Usually I’ll have an equal amount of numbers above and below my target range - whether 5 or 25.

For some it may help to stay a little higher to avoid lows but it’s not the right way for me.
It it okay to follow guidelines but doctors should not forget the individual. Some things may be different for different people.

23

This chart (like many other ADA things) is outdated. It does not reflect the latest formulas developed by the ADA. In particular, for a given A1c it runs a bit “high.” So, an A1c of 5% should reflect a BS of 97 mg/dl and an A1c of 6% should correspond to a BS of 126 mg/dl. This is a non-trivial difference.

And even Bernstein specifically says not to maintain blood sugars in the range of 60 mg/dl, it causes a variety of problems. And limited faith should be placed in such charts. This is an average, your A1c could vary significantly. Historically, my A1c has corresponded to an average blood sugar that is 20-30 mg/dl away from my actual meter average.

24

I think too that “meter averages” can be skewed as I tend to test a lot more when my BG (or CGM…) are out of whack, overemphasizing the outliers.

25

A few years ago I had problems with severe lows and my endo upped my “goal range” to 90-130mg/dl. Since then, I’m a little better with the carb counting and have been able to get my A1C down to 6 without too many lows. Obviously, if you are active, miscount carbs, or just plain forget to eat you will go low, no matter whatever else you do. I got mine down to 6 without killing myself with lows and while still feeling like I could do better. So, now my goal is 5.8 for next time. My endo is thrilled with anything below 6.5 (she was disappointed with a 6.6 earlier this year).

26

I would like to see her A1C and if she can keep it from going .1 over her last result for a few in a row? I think that the scope of the test 5.0, 5.1, etc. sort of leads one to overemphasize the significance of small moves like that?

I still get pissed if my number goes up but, at the same time, I have to wonder what the margin of error is? It’s like ERA and you have a 2.10 vs. 2.20 they are both likely to be good pitchers. Assuming some reasonable level of WHIP, BABIP, K/9, OBP, etc…

27

All of my Drs. would be disappointed if my A1c ever came back at 7.5 or even 7. They prefer 6.3 - 5.6. I noticed some years ago that the lab requirements ranges changed from 7.0 down to 4.8 - 6.0. I can do 5.8 without too many lows or much effort but I cannot and will not try for lower than that again because it wasn’t pretty.

28

When I was diagnosed, my A1C got to 15!!! It was crazy… I’m trying really hard to lower it, but I have brittle diabetes. I’m currently at 1 9.5 which is amazing for me. So don’t feel so bad about a 7. :] My doctor tells me to aim for a 6 or 7.

29

So what is the Consensus of the group ? 7 and below or the issue of less amplitude of swings ?

30

I don’t think it’s an either or. I aim for a standard deviation of less than 25 with an average meter reading of less than 110 which usually translates into a 5.9 for an A1c (I clearly miss at least a few highs :slight_smile: It is possible and perhaps easier to minimize swings with a lower A1c for at least some of us.

Maurie

31

From my experience if you’re in the 5’s and 6’s and having a heap of lows your doc is going to be grumpy, and talking to my doc/nurses that is how a lot of people get those numbers. If you can show that you can get those numbers (probably first be getting into the 6’s with out lows, if your doc is anything like mine they will challenge you to get the numbers as good and consistent as possible - without the hypo issue.

32

to clarify my post, I was wondering if the DOCTOR would be able to keep the DOCTOR’s A1C that conistent?

33

Here is my take on things. First, health goals are an individual choice. If you want to go krispy kreme yourself to death and you do it in an informed manner, that is a personal choice.



But all the studies I have seen suggest that the closer to non-diabetic you can get your A1c, the lower the rate of complications. And make no mistake, for the vast majority of us, high blood sugar won’t kill us directly, it will be the complications. And we should not kid ourselves that anything below 7% doesn’t matter, the chances of a heart attack are doubled when you have an A1c of 6% vs non-diabetic and studies suggest that retinopathy risks start to occur for any A1c > 5.5%. We all get in our cars and deal with risk everyday. It just has to be balanced.



And for some of us who have had D for a long-time, perhaps not with the best control, there may be some risks with lower A1cs. But otherwise, it seems to me that I get the best outcomes by having the A1c be as close to normal as possible while managing the risk of hypos and balancing the demands of tight control.



So in the end, the last two factors really weigh in. How well can you manage the lows and how much time, effort and resources do you put into tight control. Based on that you need to make a choice.

34

My doctor wants my A1c in the 5.5-5.9 range. I have been that range for almost 10 years. I do have frequent lows, mostly 50-70, but a few as low as the 40s. I had gradually lowered my A1c so my body would be accustomed to the lows. I can easily take care of all my lows, even those in the 40s. I don’t feel comfortable below 60, but these lows do not cause me any problems. I test 15 times per day to keep track and correct the lows as needed. I have been type 1 for 66 years, and I have no diabetes related complications, except for mild nerve damage.

35

Hi Jackie
Here in France our doc said between 6 & 7. My daughter has been 5.5 and 5.6 for her first ones, but she had too many lows & was on a too strict diet (dieteticians !!!) As I read somewhere in this thread, the quality of life is important too.
I’d say your 7.5 is not that bad. Keep up the good work you’re close to 7 !

36

OK, on my soap box. First off, A1c goals need to be individualized according to the person.I’m a low glycator – my A1cs do NOT reflect my average glucose numbers, but are considerably lower than would be predicted. Since I know that, I’m not satisfied unless my A1c is less than 6. But you may be different – how do you know that your A1c is not HIGHER than your average BGs would indicate? That’s one reason why I put very little credence in the A1c.

On the other hand, you are perfectly capable of monitoring your own BGs. Your meter will tell you if you are having too many highs and lows. Seems to me that the first goal is to tame the outliers. For me, it has been reducing carbs. For you, it may be that, or it may be increasing exercise, or whatever. You have to experiment to find out what works for you. And it’s hard work, no doubt about it.

Then, when you have established a fairly stable trend, you can work on lowering your “line”. The concept of being SAFE includes preventing or minimizing both highs AND lows. It CAN be done, but it takes a lot of attention to metering appropriately, i.e. finding the peaks after eating, and the lows after exercising, the highs of sickness, how your body reacts to cyclic hormonal changes, etc. It sort of amounts to constant tweaking, and maybe you have to be OCD to do it. I don’t know if you’re willing to go into that much detail, but it’s your body, and you’re the one who’s going to be living in it, not your doc or your NP.

I have never had a doc even GIVE me an A1c goal, which is OK with me, since it wouldn’t be appropriate for me anyway. I’ve equally never gotten a range I should stay in, except in the very beginning, when I was told that as long as I stayed under 200, that was fine. Well, no, that’s NOT fine. I have learned a lot in the meantime, but the most important thing I’ve learned is to do what works for ME. You need to do that too! :slight_smile:

37

My doc wants me to stay between 6 and 6.5. My retinologist recommends diabetics with eye problems keep it below 6, if possible, and keep their blood pressure down (high blood pressure does a lot of the same things high blood sugars to to your organs and eyes, aparently.

38

I tried to read back but w/ the page change, I wasn’t 100% sure who the “you” was in Natalie’s post so I’ll just carry on at the end.

I am not thinking that a lot of people, either docs or patients the same way as they might conceive of a post-parandial number. I’ve never had a sense that a doctor wanted me to get from 5.8 to 5.5 or 6.5 to 6.2 or whatever. It’s totally a small sample size, since you might only get it a few times/ year or even less. Then you get it and it’s there but there’s not any “quick fix” to fix it. In that sense, it doesn’t really matter and your BG numbers, of which you have like perhaps a couple thousand “embedded” in each A1C, but you only get “one shot” to see how it works out. To me, that’s why it’s important to “win” every test, either by getting a good reult or doing a good job fixing it if it’s out of whack? I tihnk that if your numbers are “off”, or aren’t where you’d think they would be based on your BG, it might also be because you are “overtesting” either when it’s high or low and skewing your meter results towards one outcome or the other? If you have a CGM, you get a third result but again, one of questionable accuracy.

I’m not sure I totally agree with discounting the utility of having a “long-term” view like the A1C provides as seems to sometimes be suggested here. If you have a chronic disease (cough cough), you have to be watching both what you can do tactically each time you encounter it and then how the little things add up into the big picture that only the A1C captures.

39

Not sure if I’m replying to what you’re actually saying, but after both my diagnosis A1c and my experience with the coma last year, I don’t trust docs to know what the A1c means for ME. For myself, I know what it means, and I do use it as a measuring stick of my own status, but I don’t expect anyone else to understand it. I’m happy enough with my recent 5.8, but it by no means equals “normal” BGs. And I do correct and try to figure things out each time I get an “off” reading, but that’s not always possible, either. I just don’t like my A1cs compared to those of others, because that will put them in a bad light, and that’s not the point. And I really don’t like to be told I’m doing great when I know I’m not. But in a way, the lack of guidance or instructions have left me to figure out things on my own, and although I learned some lessons the hard way, it really does make me the boss of my own destiny!

40

My 15 year old’s endo told him today that his optimal A1C is between 7 and 7.5. I totally disagree, I understand it’s probably because he’s a teen and they don’t want to see lows… but my gut feeling is that because it’s a pediatric endo, he really only cares about dealing with him until he turns 18 and can pass him off to the adult endo, so long term complications mean nothing to him. Whereas they mean a lot to me!
We’re new to this though… only diagnosed 9/28/2011. On the plus side, he did prescribe insulin pens, so at least things like hanging out with his friends will be easier now, without having to run home for a shot every time he wants to put a morsel of food in his mouth, etc. And he got his first look at pumps; if we can get the logistics figured out (we live on a military base in Europe) as far as getting supplies for it and maintaining it, he’ll order it for us sooner than we’d expected. First we were told he couldn’t have a pump until/unless we moved home, then he couldn’t have a pump until he’d been dx for at least a year IF they could figure out how to get one here, so seeing any progress toward it at all is very encouraging.

But I still don’t agree with an A1C of 7+ being “optimal!” :frowning: