A1c Ugh!

by Leighann on July 15, 2010

I realized that I never hit publish on this post. This appointment actually took place in March or early April. We’ve already had another appointment. Come back next week to find out how it went.

We had our endocrinologist appointment today, which we have three times a year.

Our last appointment occurred only a month after we began the pump and her A1c hadn’t budged much.

For this visit I was expecting a gold star for a much, much improved A1c.

I thought for sure that if we hadn’t reached our goal of getting below 8%, then we were certainly honing in on it.

I was incredibly surprised to hear our A1c given our BG average for March was 167, which is in our target range of 100-200.

An average BG of 167 should yield an A1c of 7.4 %.

We were not. even. close.

No. Our A1c was the equivalent of an average BG of 200!

What?!

She asked where we think we can improve. I told her that we are by-the-book and I didn’t really see what more we could be doing.

Maybe we could start counting carbs? (We count carbs religiously.)

Maybe we could start weighing and measuring instead of guessing? (We weigh and/or measure everything.)

I could not come up with a single thing that I should be doing that I am not. She said even someone with an A1c under 6 can find some area that they could do a little better.

That A1c is just perplexing. She suggested that there must be some times that we are high that our regular BG checks are not catching.

Maybe highs during the night? Though she is waking up in range most mornings.

Maybe insulin isn’t acting quickly enough after meals even though she’s back in range by the next meal?

She had two suggestions that may act as a diagnostic.

First, we can check BG’s more frequently for a week or two to see if we can catch where she’s going high. She said, “Some people check 10 times a day. But really, you have to have a life.”

Agreed.

Second, she told us about the iPro CGM. According to Medtronic’s site, “CGM technology reveals key clinical insights not apparent with fingerstick and A1c testing alone.”

Looks like us grown-ups are in for a few sleepless nights and a certain little lady is going to have sore fingers!

Here is an Average Glucose Calculator, if you are ever curious.

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{ 3 comments… read them below or add one }

1 Penny July 15, 2010 at 6:53 am

Hi Leighann,
Can I ask about your range of 100-200? It seems high to me. My daughter’s range is 80-150 with a target of 100-120. This range and target has helped with developing basals that really put her within range. I’m just curious if your endo has stuck with the 100-200 since this appt or if that has changed. Also, we average about 10 fingersticks and BG readings a day. That has helped us gain more control.
Why does it always feel like an A1C is our parent ‘grade’ no matter what we tell ourselves that it’s not? It always feels that way to me and sometimes I’m not sure how to make it not so.

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2 Leighann July 15, 2010 at 7:49 am

Hi Penny,

Her target range is 100-200 as it is for a lot of young kids her age. But we actually shoot for 80-150. We begin correcting at 150.

A1c’s of 7-8 would actually correspond with 154-183 (going by the link given in the post).

You’ll have to read next week (wink) to see what changes we ended up making and if we saw results.

Reply

3 karend1 July 15, 2010 at 8:13 pm

For what it is worth, I test every two hours, except during the night.

I have been a type 1 for 43 years and for decades never tested, but now I cannot imagine not testing every two hours, before I eat and two hours after. Sometimes I feel crappy right after I eat and I will test an hour into it and I am sky high so I do correct.

Recently I started bolusing 15 minutes before I eat and that has helped a bit as well.

Keep us posted.

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