Y’all’re great !
(I am a southerner livin’ in Memphis, so my verbal accent is slow an’ sweet.)
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That’s interesting—for me it seems really old-school, but of course you’re dealing with a kid not an adult and that’s its own thing. But it does remind me of the old days on R/N insulin when they didn’t want you to run much below 7 because it meant you were probably having too many hypos. The treatment and testing tools were so crude they figured that was the only way you could get an average (which is what A1c is) that low. Even later on, when I was doing MDI with modern basal-bolus analog insulins, I used to get grief from my endo if I was below 6.5, for the same reason. “It means too many hypos, Bill!” That was pre-CGM, so there wasn’t much data for her to work with besides the A1C and whatever I’d been setting down in my deeply resented and sparsely updated log book.
I’d also regard that 8.3 at diagnosis as encouraging, certainly not as bad as some I’ve seen people reporting, though obviously not where you want it to stay. Much less a hard slog getting from the 8s into the 7s, especially with the tools we have now, than up in the double digits.
I was dx’d in '83 and I totally don’t remember even getting an A1C until much later on. When did they first start becoming routine? I seem to recall mine being in the mid-7s when I first started getting 'em. I know my Dr in the 80s-early 90s thought I was a Bad Diabetic, but I’m probably lucky they weren’t worse. I was doing my best to ignore the whole thing—just shoot up the same amounts every day at the same times and try to eat pretty much the same thing all the time and hope for the best, with most of my fingerstick testing taking place in the last week before my appointment. As for exchange diets, did you actually manage to make that work? I never could make any headway with that.
Per wiki
The use of hemoglobin A1c for monitoring the degree of control of glucose metabolism in diabetic patients was proposed in 1976 by Anthony Cerami, Ronald Koenig and coworkers.[9]
In 1983 I moved to small town in Texas. No local endos, so went to internal med doctor, who was willing to treat my T1D. She did the first A1C test, my best recollection… She also was first to suggest I use Regular (in addition to once per day Lente. But only as correction when urine was 4+, never before bedtime or mealtime.
Few years later I moved and had first visit with “full” diabetes team (20 years since diagnosis), and introduced to NPH and exchange plan diet. BG testing started around then, visual read only, and probably got regular A1Cs. And NO, exchange diets didn’t work, but was using Reg, and dosing at start of meals (higher carb), including white bread, cereals, potatoes, etc.
But until early DCCT results, there was no proof that using A1C would aid in reducing complications.
I think I was 30-32 yrs old. when I had my first A1c in about 1981-83. I was dx when I was 8 in 1959. My first A1c was 10. Ahhhh, good old urine testing. I cleaned up my act immediately.
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I’m 63 and satisfied with 7. Before I finally went on CGM I was usually around 8 and still suffered many costly LOWS. I am now 6.8 to 7.0 and would rather be slightly high than kill myself or visit another ER.
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My A1C hangs out around 5.6-5.7 without any lows. I am good with anything 6.0 or less.
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I have found that pre-bolus helps prevent high glucose levels. If I take my meal insulin 15 to 30 minutes before I start to eat I don’t get high glucose readings nearly as much.
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The A1C is an antiquated test, that does not give any real useable information. It is a 90 day average blood glucose result. My 90 day CGM data on the other hand, gives a wealth of information that can be used to make adjustments to my regimen. I don’t even ask about the A1c result anymore, because they’re meaningless. Why doctors are still using the A1c is beyond me.
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Well I have been prebolusing for years so… I think my current troubles may be digestion related so I’m starting some probiotics and a digestive enzyme. We shall see.
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I like the A1C score, it gives a uniform base to judge by. Not everyone has a CGM, they can also be off and you can manipulate/change the data if you want to.
So the A1C gives a nice overall picture!
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Because is is easy ?
Certainly a reality.
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[quote=“Tim35, post:53, topic:79011, full:true”]
Because is is easy ?
And inexpensive?
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@Marie20 What is important to remember is that A1C is a relative, not absolute number. Your doctor may, for example, report your A1C at 5.1 and my doctor report mine as 6.0 and my actual A1C may be lower than yours. This was discovered, I believe, during the 1982-1993 DCCT clinical trial. Different labs have different protocols and methodologies and accuracy within their procedures which makes the test only valid within about + or - .5%. My 6.0 can actually be a 5.5 and your 5.1 could actually be a 5.6. There has been a push for greater accuracy and lab/equipment certification and although great strides have been made, there is still a long way to go. NGSP and others, for example, have been working on harmonizing A1C testing worldwide. I am very skeptical of patients that have a WOE and claim very low A1C’s and are not on a Dexcom CGM. Their A1C’s may be even quite a bit lower than they know or could be quite a bit higher.
Those of us on a Dexcom CGM are on a much more level playing field as we are all getting our GMI (a relative index from Dexcom that somewhat mirrors A1C) from Dr Dexcom so comparisons between 2 patients is far more accurate than using A1C results from different labs.
Using A1C as a relative consistent indicator from the same lab is certainly a very valid method for a patient that does not have access to a CGM and can work with their doctor for improvements if needed, but comparing the A1C of 1 patient to another such as we do on this board is a very dicey proposition.
Hopefully, the cost of CGM will dramatically drop over the next few years and every diabetic will have access to far more accurate and reliable data that is relavant and comparable from 1 patient to another worldwide.
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How does the user of a CGM manipulate/change the data? Honest question, not trying to pick a fight.
My Endo sticks a blood sample in a little machine right there in the Examination Room. It is about the size of a toaster.
I use a CGM and it uses interstitial fluid, not blood. She gets a TIR pattern from that. When I need to, I prick my finger.
In the hospital, I don’t know what they used.
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Same.
The cost is higher for an A1c test that gives immediate results like that but the obvious benefit is being able to use that data during the Endo appointment as part of the discussion.
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I always use the same lab, so I have faith in my A1c results. Looking forward to using the CGM though.
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@Jason99. I accidentally discovered it, but easy to think of. My CGM was off and I in reality was having a bunch of lows for some reason one day but since my CGM was off it wasn’t showing them and putting me out of range. I purposely let it stay off so I wouldn’t have the lows on my data for the day.
So you just calibrate it higher or lower as you want to. You always know how much it’s off so you can add/subtract to know what you’re at. I did that with the Libre anyway, easy enough to do.
I fixed it at the end of the day, but if someone gets lows and doesn’t want it on the data, it’s a way to get around that. Whereas an A1C is at a lab and can’t be changed.
For our own data benefit, useless to do, plus alerts would have to be adjusted. But if it was the only thing a doctor looked at???
Oh wow. I never thought about that. I’m in that situation right now, where my phone and pump have been constantly alerting me to low BG’s all morning. But, not low enough where I want to do something about it. I want to throw both of them out the window.
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