A1C-It’s Just a Number

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Yesterday, I had my endocrinologist appointment where I found out what my A1C was from blood work I had done last week.  I’ve been trying sooooooooooo hard to get my A1C not only Below-Seven but below 6.5 because my hubby and I are planning on trying to get pregnant soon.  I was so confident in my blood sugars over the last few weeks and months that I was positive I was going to have an amazing A1C, so positive that my husband and I made the decision for me to get off of my birth control pills so we could actually begin trying to get pregnant within the next few months.

The last A1C I had done was 7.3 back in June.  However, that was done a few weeks after we went to beach week, where my blood sugars stayed high the majority of the week thanks to grazing and alcohol. It was also after extensive basal testing in March and April, where I purposely kept my blood sugars in the high 200’s because I knew my basal rates were too high.  I would drop drastically, more than 100 mg/dls during the tests until I tweaked them enough to stop the dramatic declines. So, my A1C in June of 7.3 made sense because I did have some highs.  I was still disappointed though, because I felt that after I had completed the basal testing, my blood sugars were pretty solid, minus the high beach week.

After getting the June result, I was more determined than ever to get my A1C Below-Seven. I have done all sorts of things to make that happen.  I did a clean eating challenge back in September which resulted in a few changes in my eating habits overall such as limiting my carb intake and for the most part cutting out Diet Cokes.  I have been working hard to pre-bolus before meals.  I have been running a TON, at least four times per week.  I’ve been getting used to lower blood sugar numbers and I’ve been trying hard to not treat unless I’m under 70 (which sometimes it’s hard to do when I feel really low in the 70’s). I lowered my targets and high alerts on my bolus wizard and CGM.  I’ve been checking Accu-check’s website for their A1C calculator almost daily, putting in my 30 day average glucose results from my test kit.  My test kit only gives a 30 day average for glucose results and but since I’ve been checking for weeks, I was confident my A1C would be Below-Seven, debating if it would be closer to 6.2 or 6.3.  For as long as I can think back, my average glucose result on my test kit stayed around 130.  Sometimes dipping as low as 126 but never more than 131.  There was no doubt in my mind that this was going to be the best A1C of my life and I was going to get to start talking all about babies.  I had even mentally prepared my blog post to celebrate my amazing results and popped the champagne bottle (OK not really on the champagne), I was so confident.

I went to my endocrinologist appointment yesterday morning.  I was so excited.  Will it be 6.2 or 6.3??  My husband warned me not to get too excited about it being that low and I thought to myself, he is right, even if it’s as high as 6.5 I’ll still be happy.  The doctor walked in and she asked me if I had heard my result from the nurse yet.  Nope, still waiting I said, hopeful.  Then she broke the news to me:

7.0

7.0 she said.  That’s great for most people, she said.  You should be proud of that number, she said.  Most of my patients would rejoice at that number, she said.  I was processing these words she was telling me, all the while trying to hold my tears back.  Yes, 7.0 is amazing. But I’ve been trying to get my A1C Below seven.  Sure 0.1 isn’t too far off, but not only was I hoping for a number in the 6’s, I was hoping for a number in the low 6’s.  I was completely shocked.

She basically spent the rest of the 5 minute meeting (I seriously only met with her for 5 minutes!! with a lovely $50 co-pay), trying to keep me from crying.  I have a pretty expressive face and I’m sure she could tell I was on the brink of a flood.  She didn’t give me any advice or tips other than to keep trying and then I left the appointment, driving home trying even harder not to break out into a complete sob.  The best part of the drive home was when my CGM high alert went off…F*ck you CGM/diabetes! Finally, once I got home into my husband’s arms to let the floodgates open.

I’m not sure if I sound silly for being so upset.  I have just been trying so hard and I was so confident I was going to have the most amazing, baby-ready A1C ever.  My husband and I are ready to have a baby.  I went to the appointment ready to hear the news we could start trying and armed with lots of questions for the doctor about the next phase of my life.  Instead, I didn’t ask her a single one of my many questions.  The doctor did tell me it wouldn’t be the end of the world if I got pregnant with an A1C of 7.  But for me personally, I don’t want to do anything to add any possibility of additional harm to my baby, so I want to have the most perfect A1C I possibly can.  Maybe 7 is the best I can do, I don’t know.  I have been trying so hard I really don’t know what else I could do differently.  The doctor gave me no advice since she thought my CGM graphs looked nice (I don’t even think she really looked at them to be honest).

After crying to my hubby, I started to collect myself.  I was so deflated and disappointed but then it turned to a slight anger.  I’ve been trying so hard recently.  It made NO sense to me why it was so high.  When I was at the doctor, I asked her if it was possible my test kit could be wrong, since I had heard another blogger mention that in a post recently.  However, I tested my blood sugar last week right after my blood work and I was 117.  She told me my blood work also said I was 117 when I got my blood drawn.  So nope, it appears my meter might be OK.

7.0 is my best A1C ever.  I should be happy.  But when I think back to my second best A1C result, I think about how I was 7.1 back in December 2011 and I wasn’t even trying.  I wasn’t obsessing over my blood sugar like I’ve been recently.  I was too busy enjoying life since I had just recently graduated grad school and gotten married.  How on earth could I have been so good then and pretty much the same now with all of my effort recently.

I began to wonder what my blood sugars were back in late 2011, so this made me think about my CGM reports and thankfully I’ve stayed a Medtronic customer for years.  I can go back to December 2011 to see what my blood sugars were like (click to zoom in more). Screen_Shot_2013-10-23_at_10.02.53_AM_1

Back in December 2011, when my A1C was 7.1, my average glucose reading was 198!  My numbers are all over the place and majority above the green in-range mark.  If I plug that into Accu-check’s calculator, that results in an A1C of 8.52!  Way off from 7.1

Screen Shot 2013-10-23 at 10.33.13 AM

To be honest, I’m not really sure what happened then.  My meter checks and sensor readings didn’t correlate to a 7.1  This made my husband question the accuracy of an A1C test and he started googling.  While he was busy researching inaccuracies of the test, I decided to go back and look at my 12 week average of sensor readings from the last 3 months.  With Medtronic’s tools at my disposal I saw this:

Screen_Shot_2013-10-23_at_10.32.23_AM

I had been so busy looking at my test kit’s average glucose result, which is only 30 days long, that I completely forgot I had this graph I could look at.  I had forgotten that August wasn’t really the best month (I was competing in a triathlon so it was hard to regulate my blood sugars because I was exhausted from all the swimming, biking and running). An average glucose of 152, translates to an A1C of 6.92.  Hmm, maybe the A1C is a more reliable test than I was just giving it credit for.Screen Shot 2013-10-23 at 10.33.36 AM

To see how bad August messed up my latest three months, I ran the same graph again but only for August (4 weeks):

Screen_Shot_2013-10-23_at_10.31.51_AM Screen Shot 2013-10-23 at 10.34.41 AM

My average from back in August, would have resulted in an A1C of 7.5!  Now it’s all making sense.

If I look at the last two months and the last month, you can see I’m finally on the right track:Screen_Shot_2013-10-23_at_10.32.15_AM Screen Shot 2013-10-23 at 10.34.09 AM Screen_Shot_2013-10-23_at_10.32.03_AMScreen Shot 2013-10-23 at 10.34.27 AM

So based on my last month, I really would have had an A1C of 6.2 and if it only looked at two months, my A1C would be under 6.5.  I was so discouraged and upset at my doctor’s appointment but looking at the last two month’s, I have been doing a LOT better and I just need to stay optimistic and do as the doctor recommended and keep on trying and doing what I’m doing.  And hopefully when I go for blood work in two more months, in December, I will have this awesome month of October plus two more awesome months in November and December to contribute to a low A1C.  I’m still not sure what happened in December 2011 since it was so drastically off, but at least now I know that August contributed to my results today and I just need to keep on trying.  While I’m waiting for that magic number to appear to tell me I can start reproducing, I have to keep in mind that the A1C is just a number.  I’ve been 200% better this past month than I have ever been in my entire life.  Sure, August might have skewed my results today but I’m still doing well and I just need to keep it up.


20 thoughts on “A1C-It’s Just a Number

  1. Keep up the GREAT work!!! I can completely relate!!! I’ve been trying to keep my A1c below 7, and like you closer to 6.5. Let me know if you have any questions, I’ve found some tricks that have been helpful to me.

  2. I’m so sorry that your A1c wasn’t what you expected. But you’re definitely making good progress toward meeting your goal and I bet the next one will be closer to your expectations. At least you reacted to the number by analyzing and tying to understand it rather than eating multiple hot fudge sundaes….

    • Well after the analyzing I did take a “break” from diabetes yesterday because I felt so burnt out and upset that I did go out to dinner, eat chicken fried rice and a chocolate brownie for dessert (WAY more carbs than I have been eating recently) and my blood sugar shot up to 362!! I haven’t been above 250 in forever it feels like! But I felt like I needed that last night and I’m back on the horse today, doing much better.

      • Since I’ve been working hard at eating lower carb as you have, I do find that when I “cheat,” the highs are much higher than they used to be. I don’t know whether we actually become more sensitive to carbs or whether we just end up with overall less insulin in our systems to deal with yummy things like brownies.

  3. Yeah, unfortunately the A1c is reflective of three months, not just 1 month. However, since RBCs are constantly dying off, the most current month is the most reflective in your A1c, which is why you were 7.0 and not 7.5. The most current month helped drag you back down. If you are already starting the next three months in the 6s (so to speak), then your next A1c will definitely be in the 6s. You’re pretty much already doing what you need to be doing, so just keep it up!

  4. You are so on the right path, and as you discovered towards the end of your post, you’re even more in the right direction than you may have initially thought!

    I’ve always found November and December to be the most difficult months, and you’ve already set the bar pretty high for yourself (or low; whatever) in September and October, so I wouldn’t set my sights on a Below-Six just yet. But anyway, you’re doing great! Keep it up!! (And what a great job you’re doing demonstrating the power of Carelink, too!)

    • Thanks Scott! I don’t even care about being below 6 haha, I just want to see an A1C that reflects my efforts and what I was expecting, for instance a 6.5 or lower. Still this was my best A1C ever so I really should be happy, it was just a little hard to take when the results weren’t what I was expecting. Hopefully I’ll be there in December but you are right, the holidays might be a little bit of a challenge.

      And yes, despite the issues getting Carelink to work, once it actually works, it’s amazing! Being the math dork/analyst that I am, I loved being able to go back and review past months and years. 🙂

  5. You are I are basically the same person right now. Had a completely shit A1c 3 months ago, figured some crap out and just got the best A1c I’ve ever had in my life. (post to follow)

    • AHH your blog was the one I mentioned in my post! I remembered reading your post about your A1C result and finding out your meter was probably wrong. I read it several months ago so I couldn’t remember who wrote it or when although if I wasn’t being lazy, I could have looked it up because now I remember that I mentioned you when I did my Favorite August blog’s post. So glad to hear you ended up getting your best A1C ever recently! I look forward to reading that post!

  6. Kelley, I know it doesn’t seem like it, but that’s an amazing result. I read a tweet somewhere (may have been from Kelly Rawlings) that mentioned an A1c under 7 usually has a lot of time where the patient is under 70 mg/dL. Doing it the way you have is way better than that. Sounds like your judgement is sound, so there’s really no advice I can give. I know you’re on the right track.

    • Thanks Stephen 🙂

      Yeah, I remember hearing that stat! I’m very rarely under 70 so maybe I don’t have as much help as others when reducing my A1C but like you say, what I’m doing seems a little safer/better although I’m sure it wouldn’t hurt if I hung out in the 80’s a bit more.

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  8. You are doing great. I just wanted to give you a hug reading this. I know it’s so hard to get a t1d body baby ready, its tiring and frustrating but I know you can do it!

  9. I know how frustrating it can be to work so hard and not see the payoff that you wanted so, so much. I’m impressed with how productive you were after the appointment, though. I would have wallowed in self pity for a while 😉 You’ve got your sight set on that goal and I know you will get there.
    Hugs!

    • Thanks Shara! I definitely did wallow in self pity that night, but during the day I went from a disappointed/sad wreck to angry then the drinking/carb loading, I mean self pity, took over 😛

  10. It’s so so hard to hear that number when you’ve been working your butt off – I had a similar situation this time around too for my A1c and it can be so discouraging. But that’s where the real courage with this disease comes in. It’s all about having the courage to get up the next day and keep trying, as hard as it is to do. You’re going to get there! I know it!

  11. I googled “an a1c below 7” and i got your blog. I guess this is the HolyGrail! The only way to attain it is have a ton of lows just b4 your endo appt or luck out and have the 20 percent lower or higher average fluctuation rate of the test go in your favor.

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