It seems that health professionals can’t agree on the levels we should aim for - some say around 7 is fine, some suggest we stay under 7, and some these days are pushing for under 6.5.
Personally, I am aiming to get less than 6 (5.9999 would do me!!) but have so far not made it. I will some day! In the meantime I’m really quite happy with results in the low 6s. Aiming for the 5s keeps me motivated, even if it’s not an easy thing to achieve as an insulin dependent diabetic.
So what do YOU think is good? Regardless of your actual results - what do you think is safe? What’s your target, if you have one? Do you think it’s achievable with your current regime?
If I could ever get below 6, I would go out and celebrate! The lowest I have been is 6.1, but have been in the 6s for the past 3 or 4 years. Last one was 6.7 and doctor told me, with my determination and “excellent management” (his words), I can do better! I’m working on it. I kind of fell off the wagon (with my eating habits) so I really need to do better and get that A1c down.
The issue seems to be a divergence for type 1 and type 2 people. The real issue is that glycemic variability is a HUGE issue for people with type 1, whereas the standard deviation for most people with type 2 is about 1/4 as much. For many people with type 1, going down to 6.5 is unsafe, because type 1 patients (unlike type 2 patients) have damaged counterregulatory function caused by the autoimmune attack on their islets of Langerhans which also contain the alpha cells which produce glucagon (most type 2s, even those who require insulin, still have fully functional counterregulatory function).
While its ideal to be as low as possible, recommendations like that are simply not safe for everyone with diabetes, because it may result in too many hypos, and I think the continued reduction in the numbers has increased the risk to patients with type 1, and we have seen a significant increase (56,000 per year) of emergency room treatments due to hypoglycemia with current treatments. My own A1c is close to 6 (5.8 to be exact), but some of that is due to hypos which lower the average figure and don’t tell the whole story. In general, if I stay below 100, it will invariably drop to 60 or less unless I eat, so I would say that an A1c of 6 or less is not only unrealistic, but downright dangerous. Any doctor who recommends an A1c of 6.5 better be darn sure they aren’t putting their patients into short-term risk to reduce (not eliminate) the risk of complications.
Right now I try to work on improving wherever I’m at. If I’m at 8%, I would immediately want to lower it to a 6.5%, even if that’s “ideally” where you’d want to be, just because I think it would be really hard to change your routine so drastically and not have issues like lots of lows. Right now, my last A1C was 7.4%, and my lowest ever is 7.2%, so I’d like to get back down to 7.2 or 7.0. Then I’d like to hit 6.9, and just keep going. And then hopefully try to maintain whatever seems right for as long as possible. I’ve heard that your risk of complications has as much to do with the deviation as the actual average, and I have a pretty high deviation right now, so I want to work on that.
I hear you. I have always been below 7.1 but never below 6.4 and my doctor tells me the same. I would say that a great A1C is below 6, but a good A1C, like Allison said, is always seeking to improve your numbers!
For an adult with Type 1 diabetes, I think a “good” A1C is anything under 6, and an “excellent” A1C is anything under 5.5. Endocrinologists will tell you anything between 6 and 7 is fine, but I don’t buy it. People who don’t have diabetes have A1C’s of 4.2-4.8. My feeling is that the closer I can bring my numbers to those of a non-diabetic person, the better my chances of avoiding the complications of diabetes. Through a tight control regimen (testing at least six times a day, and giving MDIs) I have achived an A1C of 4.9. So I’m proof that it can be done!
I know for a lot of people that getting under 6.5 or 7 (or wherever your tricky point is) results in a lot of lows - but for lots of people, it’s not like that.
As I see it, It depends on your methods of control, and how often you test. For me my a1cs in the low 6s give me no trouble. I’ll have the odd minor low, as ya do, but have to date never had a serious low, never been hospitalised, and always been able to grab a drink or food to sort myself out quickly.
It also depends on your lifestyle - I’m in a good position there because I have a fairly free lifestyle, staying at home most of the time home schooling my son. We don’t all have the ability to test so often and inject / eat as we need to.
Susan - 4.9 - WOW! Well done Bernstein by any chance? I know I could get my numbers lower if I could eat that way, but I don’t… so far… However keeping my meals balanced and testing a lot has already got me down to where I am, and I’m pretty determined to go lower, so we’ll see. I learn as I go!
Rachel: I get an average of about three lows per week (by “low” I mean anything 65 or lower). My target range is 75-100. I correct for anything over 100. I know these are tighter numbers than most people aim for, but I really feel best when I’m in this range. Sure, I get highs, but usually only if I over-correct a low. Like the other day – I had a low of 51, so I shoveled in some candy, followed by ice cream and a bowl of cereal. Well, you can guess what happened – I tested a half hour later and there I was at 180. Ugh! Had to give myself another shot. That doesn’t happen every day, fortunately!
M.: Nope, I don’t follow Bernstein. I admire people who have the discipline to follow a diet, but I love carbs too much to give them up. I eat whatever I want, whenever I want – I’m just very, very anal about giving myself the right bolus and then testing two hours later to make sure I’m in the right range (75 to 100 is what I aim for). If I’m any higher than 100, I give myself a correction. It took me a while to get to this point; I know my body pretty well by now and I can predict what food items are going to send me high and which ones won’t affect me as much. Chinese food, for example – I have to give myself an enormous bolus for that if I don’t want to be in the 200s two hours later. However, I can eat a non-fat yogurt (18 carbs) and it will only raise me about 10 points. Like you, I learn as I go, and I’m still learning.
Deborah: That’s what the ADA will tell you, because it’s very hard for many diabetics to get their A1Cs lower than 6.5, and they’ve set different standards for diabetics and non-diabetics. But a non-diabetic person does not have an A1C of 7, 6, or in most cases, even 5. An A1C of 7 means that person has an average blood sugar level of 150. Non-diabetic people don’t have blood sugars that high. They may spike up to 120 or so after a meal, but shortly thereafter they will drop down to 85-100 – which is a “normal” non-diabetic blood sugar range.
For years I had A1cs in the 5 range and even hit 4.9 twice. I was also have many extreme lows. There were some days where every single BG test I did was low. Not 65-70, but 31-35 mg/dl. My last 3 have been 6.0, 6.0 & 6.4 (6.0 being the most recent). I still have some lows but they’re not the killer NPH lows that I used to have while on injections. I also test a lot more now so I can catch myself before I even go low.
I’m happy right around the 6.0 range. If I could get back to the 5s without having many lows I’d be even happier.
I’d have to agree with what many folks have said here - I’ve had A1Cs between 5.4 and 6.2 for the past 5 years or so. When I’m lower than 6.0, I’m usually having lows and rebound highs. But, if I aim for 6.0 and get it, more often than not, my meter is reading between 80 and 140 or so consistently. Which, I think, is good for me. If I tried for something lower than 5.0, I’m certain I’d either make myself crazy or kill myself by means of hypo.
My mother and brother, both non-diabetics, have for years had A1Cs at over 5.0 - sometimes as high as 5.7 - these are within normal range (4-6%) - so I believe if you’re in the 6s or even at 7.0 - and you’re avoiding bouncing ball sugars, you’re doing really great.
4.9% is GREAT, if you can manage it - congratulations!
Geese louise, I have always been told that 7.0 or under is great. I will have to also agree with Scott here, though that the risk/reward for type 1 and type 2 are and should be different. Having had type 1 for 25 years, my dr insists that the statistical difference between a 6.5 and a 7.0 is so slim, that there are more risks that can occur from low blood sugars than the differential in the A1c. I keep myself between the 6.5 – 7 mark and am very happy with that. Lately I’ve been aiming for lower to get ready for pregnancy, but there is no way I can imagine an A1c in the low 5’s. I am comfortable and happy with my standard ‘under 7 is great’ I think that, for me, there is a fine line between great (6.5ish) control and a great well balanced life and what it would take to have extreme control.
Wow. I am just not disciplined enough to get under 6. Quite frankly, that would scare me. My internal med person wants me to stay below 6.5 while my endo is more concerned with keeping consistent BG; right now, I’ve got severe highs and sever lows. I’d say my target is 7 or below. I’ve never had an endo try to push me below 6.5…it does get confusing when everyone believes something different!
My last A1c was a 6.6. It was the lowest I can ever remember having one, but there were many years when I didn’t have one done. I would love to shoot for a 5.8, but we will see.
7.2 or lower - but I dont expect to get below 6.5 without radical lifestyle changes which I am not willing to make. At 7.4 I make major adjustments. My last was 6.6.
When I was pregnant i was 5.9, but it was insane to be there - my son was still giant - 10 weeks early and a whopping 4 lbs 12 ounces. My highest ever was 8.5 when I was 13 or so…i have been lucky - self awareness served me well in my childhood.
Started with Dex CGM this month…we will see if he can help at all.
just want to send some love and encouragement to all the type ones who try really hard to manage their diabetes every day and still aren’t anywhere near the numbers y’all are talking about.
Bernstein by any chance? I know I could get my numbers lower if I could eat that way, but I don’t… so far… However keeping my meals balanced and testing a lot has already got me down to where I am, and I’m pretty determined to go lower, so we’ll see. I learn as I go!