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BSparl: How on Earth Did THAT A1C Happen?

I've had a lot of trouble controlling my late second trimester blood sugars, as I've written about all over the place in the last few weeks.  But it's true!  While the first trimester was crammed with low blood sugars, this second bit has been plagued with 200's ... and some of them fasting.  (I hate the idea of waking up high.  Makes me feel like the day gets off to a miserable start.)

Baby girl Sparling, 25 weeks along

I have been working very, very hard to keep track of these numbers and doing what I can to keep any highs from hanging out more than an hour.  But still, there were highs.  And not as many lows.  

So how on Earth did my A1C go down again this month?  I'm confused!  

Last week, I called Joslin to get the results of my most recent bloodwork, and when the receptionist answered, I was braced for the worst.

"Hey, this is Kerri Sparling.  I was calling to see if my A1C result was back yet."

"Let me check," the receptionist B said.  

I couldn't keep my mouth shut because I was just certain that it had gone up.  "I'm pretty sure it's going to suck a little bit."

B laughed at me.  "What?  Well let's just see then."  I heard her clicking on things and shuffling papers.  "Okay, Kerri.  Well it hasn't gone up.  You're at 6.0%."

"What?  I don't mean to sound like a jerk, but are you seriously looking at my chart?  I've had some really rotten blood sugars this past month.  But it's lower now?  How the heck did that happen?"

"I don't know.  Maybe you're getting those highs down faster than you think."

"I'm shocked.  But I'll take it.  Whatever's best for the baby girl, right?"

We hung up the phone, but I didn't feel particularly proud.  Believe me, I'm not complaining at all about an A1C of 6.0%.  Not even close to complaining.  But I know that I've been doubting the accuracy of the A1C for a while now (wrote about it a few months ago, when I was up in the 7's and distressed about those results) and now, after getting the lowest result in my entire history with diabetes, I'm not sure how I got there.  A few weeks ago, I understood why my A1C was lower because my overall blood sugars were lower.  I wasn't over 180 mg/dl for weeks on end.  Now?  I've seen a pile of highs, yet my A1C is at the tail end of six.  I'm happy with the number itself, but not sure it's completely accurate.

It's weird, what being pregnant has done to my mentality.  Before BSparl was thrashing away in there, I wanted an A1C of 6.0% so badly that I was willing to do anything for it.  Now?  I'm sitting pretty with an A1C of 6.0% and wishing that it was definitively the result of steadier numbers.  I want what's best for this kid, and I'm hoping that this number is indicative of a safe little environment for my daughter to flourish.

Because God only knows how I'll manage to screw her up once she's on the outside.  ;)

Comments

Kerri: It's hard for me to get 6% and I'm not pregnant. My last A1C was under 6 and I thought it would be off the charts too. Turns out that being vigilant with the CGMS and doing small correction bolus' two hours out did the trick for me. Good job. Can't wait to meet SheSparl.

Diabetes or not, pregnancy does very strange things to the body. You are doing great; don't question it.

Congrats on your a1c! Even if you're not certain how it got there, you still deserve a congratulations :) I know you have more at stake right now with your pregnancy but I'm glad I'm not the only one to wonder about the accuracy of a1c results. For 3 years since pumping & actually tightly managing my BG I've yet to see a huge improvement in mine. Which is extremely frustrating to say the least. I've had one 6.4 about 2 years ago but think that was a mistake. Honestly. Then my last one was 7.3 which was down a whole point from the time before but I was having problems with highs! Like you, it doesn't make sense! I'm having my next one tomorrow and am already having anxiety about it. But keep up your good work ... it's obviously paying off :)

I know what you mean. While I've never seen a 6.0, I have had appointments where the results were much better than expected - as well as times where I was expecting my best a1c ever, and found out it had gone up a full point. I've decided that, for me at least, it's just a totally random number, bearing little resemblance to my 24/7/365 dexcom averages. My endo may try a fructosamine test next time too, just to check if my a1c is really as far off as it seems sometimes...

You are doing the best you can for little bSparl. Try not to stress out over any numbers - particularly good ones! ; )

You are doing a great job. Kids have a way of making us think differently about life and everything else. Whatever your doing, your doing great. Keep up the good work.

First of all congrats on the great number!

About the accuracy, I read once that the A1C is not as accurate when you are in tight control because the cells that they use to measure it are not dying as fast as if you were in poorer control. So even though they test it every 3 months (or more when we're pregnant), our results could be showing the levels from 6 months ago (because the cells from 6 months ago haven't died yet.) Mine has been exactly the same two months in a row, but based on my meter, it should have been higher this past month.

Yaay congrats! It was my experience that after I had my daughter I continued to have really low A1c's thanks to nursing the first year. Unfortunately the nursing caused a lot of the first trimester-like crashes too, but hey! All in the name of good blood sugars and healthy babies. :)

I understand your A1C confusion, but still wanted to say congrats on the awesome A1C. BSparl is in very good hands, or maybe I should say belly at this point ;)

Just theorizing: what about blood dilution? If you produced a lot of fresh blood last month (I know that it happens during the pregnancy, but no idea when), it might have diluted the glycated part.
Otherwise no idea. If you would have both highs and lows, then it would be obvious (my best HbA1C was when I was roller coasting after my first baby).

Anyway, I think everything will be fine for you and BSparl :)

Well, like you said, whatever is best for the baby. My guess is the same as B, you are getting those highs down quickly.

I think it goes to show you that you are doing a great job at providing for your baby already.

Awesome.

Consider it rent paid by your little border. ;-) They take your energy and food and bladder control. The least they can do is give you heat in the winter (they won't give you AC in the summer though, so call the super) and an A1C that lets you sleep at night (because they don't and won't - forevah). Congrats!

2010 truly is the year of the sparling. A huge success at Sundance, BSparl on the way in May and now a 6% A1c? Girl, ya'll are just en fuego!

Hgba1c (or a1c) is the amount (or percentage) of glucose stuck to the hemoglobin in the red blood cells.

In layman terms, the higher the glucose concentration in the blood stream, the more likely that the glucose is going to stick to the red blood cells in the blood stream. A1c measure what percentage of the hemoglobin (part of the red blood cells) have sugar attached to it. The higher the a1c, the more glucose the red blood cells were exposed to.

It's an approximation of 2-3 months of blood sugars becuase red blood cells only last for 60 to 90 days before they break down. We make millions of red blood cells every day, while also simultaneously having millions of red blood cells die every day.

The interesting thing about a1c is that there is a relation to the amount of time that the red blood cell is exposed to glucose before the glucose gloms on to the red blood cell.

So, if your glucose is over 200 mg/dl all the time, you're a1c will be higher (more time for the glucose to stick to the red blood cell) than if you are diligent and you check you blood sugar 2 hours after eating and correct for the higher sugar with more insulin - thereby resulting in a "normal" blood sugar in an hour or so.

So, if you do go high, then the best thing to do is to correct right away. This will result in a lower a1c but also will result in lower complications than if your sugar was high all day instead of a few hours.

If you look at people without diabetes who get a large carbohydrate load, their blood sugar might go up to 150 or 180, but it always returns to "normal" within an hour. A non-diabetic doesn't run around with a blood suagr of 75 all day - it can vary alot. (as a side note, so don't beat yourself up for variations in blood sugar - it's normal.)

So while, for a diabetic, a post-food 200 sucks, getting back down quickly is the best thing for you and your a1c.

So, if you are having highs but are monitoing your sugar closely and are doing what you can to get those highs treated, then your a1c will look pretty good.

Good luck with everything!! (oh, yep, I am a doc)

I was never able to get my A1c below 7.6% before I was pregnant.

However, when pregnant I attacked those blood sugars. I erred on the side of low as often as I could - knowing I started my pregnancy at 9.6% I was doing everything I could to keep it from hurting my little girl. I got my a1c from 9.6 down to 7.8 in 6 weeks, largely because of a ton of lows.

Still, 2nd trimester resistance was awful and I spent so many days wrestling with 200's. BUT because I was much quicker at getting those highs under control and obsessively checking my bg my A1c's quickly got down to 6% and in my 8th month I had a 5.8 with a 5.6 One month postpartum.

My doctor said it was because of a lot more swings I was having that I wasn't able to catch - especially night ones. I'd drop real low and not know it because I had had so many and symptoms often change during pregnancy - which they did for me.

Really it's those nasty swings from high to low to high to low that can reflect a fantastic a1c but not consistent control.

You're doing great, Kerri. Don't worry about it too much. Your body protect that baby so much better than you know and you're doing the best you can!

I was the same way in the 2nd tri when the resistance was starting to hit me hard. I expected terrible A1C’s and they stayed great. My theory was that I was wearing a CGMS for the first time, testing 4 times as often as my non preggo self, and catching highs right away and correcting the heck out of them immediately.

When Paige was still in the belly, I had the attitude of “As long as I stay conscious, I’d rather be low than high!” So I tended to correct numbers when I still had active insulin to get my postprandial numbers down.

As my OB would say, “just keep striving for perfection but understand you will never achieve it.

Honey, I'm not sure I understood a single word you said, but look at that baby belly!!!!!

I'm still so happy for you.

Kerri, seriously, stop stealing my blogs ;) I got into work this morning with a voice mail from my doc with my a1c results... I had no doubt they would be bad with all of the 2nd and 3rd (ahhh, THIRD) trimester highs I've been having. It was stable, moved up .1. I was just thinking about how inaccurate A1Cs must be and questioning whether I could really do a good job and keep on top of what I need to when even the blood tests aren't telling me the truth... when I read your post.
Ultimately, I think you and the commenters are correct... I guess since we are aware of the highs so early on (even when we wake up to them) that it isn't affecting our A1C like we think it would be, but I think because we carry around the guilt for so long, it FEELS like our a1cs should be just horrible... That's my theory and I'll just try to convince myself it's true, until I have that baby girl in my arms and I know all really IS well.

I've been told that just because of the way the A1c is measured, there is no way to avoid variations up to .3 %. So 5.9-6.5 could all be results of the same blood, just because of statistical variations in the measurement. (Not sure how much this is dependent on the method they use though - pretty sure in Germany there are at least to different used.)

Good luck to you and BabySparl from a "lurker"!

YOU GO GIRL! (Totally 1990's, right?) I'm so proud of you! 6.0!!! Woo hoo!

That a1c is AWESOME!!! Your doing great and I only hope if I'm ever in your shoes I can do that well :)

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