What the mean really means…
I felt as confident about knowing what my most recent A1c would be as I do about betting on horses at the track (read: not at all). So when I walked in to my appointment with my CDE on Monday morning, his guess was as good as mine. The nurse who roomed me set my chart down on the table while she took my blood pressure. It’s gotta be up in the sevens I told myself. Months of half marathon training, plus the holidays, plus a crazy busy work schedule had meant a lot of ups and downs the past few weeks, and I was sure my A1c would show it.
I stared at the chart while she took my pressure, trying to Jedi mind-trick it closer to me, as the anticipation was driving me up the wall. Finally when she was done, I scooted over to it and saw….6.3%.
Huh? I was shocked at the number for a minute while I mulled it over. I liked the look of it, since my personal goal is to stay below 6.5%. Was I doing better than I thought? I pondered? Did I just get lucky?
Then logic took over and realized that I can’t really take credit for that A1c. An A1c is an average. The average of a blood sugars between about 80 and 120 for three months is about 100. But the average between lots of 40s and 50s plus lots of 280s and 320s is also right around 100. And that formula, my friends, is how I got that A1c. Wide swings in my BGs from all the running, carb-ing, over and under bolusing, and the general nonsense that has been my diabetes management for the past few months made me average somewhere in between that whole mess. And that’s not how I want to earn a 6.3%. In fact I’d take a 6.7% with a flat-lined DexCom over the peaks and valleys of the past three months. And that is EXACTLY my new goal - fewer highs, fewer lows, and more time between the lines on the Dex.
That bit about fewer lows is especially important: I talked to my CDE about my recent increase in hypo awareness, and I saw his usually relaxed face grow concerned. “These are the lows I worry about the most, because they can get you at a really bad time” he said, not needing to outline what a bad time would be since I already know what he meant. (Shudder.)
He told me that for the next month my goal should be no hypoglycemia at all - a tall order considering I get a few a week. He said that even if that meant running a little bit higher, I need to make that a priority. In his experience, he said patients of his who took a month to “re-set” the hypo memory if you will by avoiding lows for a while were able to keep further bouts of hypo unawareness at bay. And I like the sound of that. So for the next four weeks, this means keeping a close tab on my numbers. I might need to velcro my Dex to my lapel so I don’t have any excuses!
I don’t want to sound like a whiner, because a 6.3% is actually a pretty good number on paper. It’s just that I know in my heart and in my over-thinking mind how I got there, and I think I can do better - and more importantly, FEEL BETTER. Nothing wears you out more than those gargantuan swings in BG. So here we go with project no-low! Blood sugar, I’m officially stalking you….watch out.
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Comments
@Johanna
T1s generally have “spiky” BG levels compared to T2s. That’s why we’re more susceptible to lows than T2s. The A1c is literally a measure of the amount of glucose that adheres to a type of hemoglobin in your blood. Because our bodies completely replace our blood volume in about 12 weeks (think about the amount of time they ask you to wait before you donate blood), measuring this type of hemoglobin gives you an accurate measurement of the amount of glucose in your blood over the past three months. It’s a measurement of ALL your BG levels over that period, highs or lows.
I only check by BG 3X a day (I’m Type 2) so I don’t get as clear a picture as you do with a CGM. I’ve never thought of the A1c as being an average of highs and lows before. Thanks for the nudge and Happy V-day.