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A Real A1C.

Last week, I had lab work run to review with my new primary care physician (my previous one, after only a year, is leaving the practice, which sucks because she was great, but thankfully, the new guy seems cool, only he wears a bow tie and I'm not sure how I feel about that, or how I feel about this massive run-on sentence).  It was standard stuff, including an A1C, and my new doctor and I reviewed all of the results at my appointment this week.

And for the third time in a row, my A1C is at a level I'm happy with.  It could drop a small bit, but if it stayed where it is for the rest of my life, I'd sleep fine.  But what makes this recent run of decent A1Cs different is that this time, the number is reflective of real numbers, instead of the averages of highs and lows. 

Here's what I mean:  I've had A1C results that were higher, but that number was a reflection of a lot of normal to high blood sugars (100's to 160s), with some true highs thrown in (over 160), and very few lows.  Conversely, I had really, really low A1C results during my pregnancy that were the direct result of running low all the time.  (ALL THE TIME, like bowls of cereal eaten without a bolus and I'd still end up at 60 mg/dL kind of lows.  Crazy hormone town.)  After a low over a year ago that really threw me for a loop, I was very edgy about low blood sugars and actively avoided them.  This meant a higher average run, and few lows due to a lack of aggressive corrections. My endocrinologist  suggested that I raise my blood sugar "correct to" goal to something in the 140 mg/dL range, instead of 100 mg/dL (where it was before, during, and after pregnancy). 

Over the course of a few weeks, that hypoglycemia fear eased back a bit and I felt comfortable with a lower blood sugar goal, but I was still edgy about lows.  I started being more vigilant about tracking and correcting highs (thank you, Dexcom, for giving me a heads up on those highs as they start to creep in, versus finding out about them once I'm already high), which began a steady, but slow, decrease in my A1C. 

Visual courtesy of one Birdzone

And this is why I'm fine with my A1C result, as it stands right now.  Because it's not an average of a pile of lows and highs and some in-between numbers.  It's a reflection of blood sugar values that are, for the majority of the time, in a range that's on target, without throwing in a bunch of lows to cause the drop.  It doesn't mean I have anything remotely close to figured out, but for this moment in my life, I'm not actively fretting about my A1C.  (This is a novel feeling.)

"So what you're saying is that you're fine with this number?  Because I'm fine with this number," my doctor said, fiddling with his bow tie.  And then he paused.  "Not that I need to be fine with it, though.  This is your diabetes."

This is why I'm okay with my A1C right now, and with my new primary care doctor.  

Only I'm still deciding how I feel about the whole "bow tie" thing.

Comments

Did you laugh when you saw the bow tie? Glad BG's are better. Lows scare me x2.

"It doesn't mean I have anything remotely close to figured out"

I'm picturing your new doctor as Al Franken.

WAIT!! You mean *this* is your new Doctor?!? http://www.youtube.com/watch?v=vPGTizdGwSc Things could get mighty interesting for you...

According to Dr. Who, "bow ties are cool." Good work on the A1c!!!

I hate to go off-topic here, but I'm a little jealous of your super deluxe 3-digit alphabet toy. Ours only has a slot for one letter at a time. Do you still get the "Every letter makes a sound, A says ah!" song, or did yours come preloaded with Chemical Brothers remixes?

Hi Kerri,

As always, your post hit it right on the nail for me. The photo of Birdy's toy with the A1c letters especially. My husband and I are looking forward to having our first baby, but in the interest of having a healthy pregnancy and a health baby I am (we are) focused on a more favorable A1c before we begin trying. This photo is perfect continuing motivation.

I also wanted to comment on the fact that you don't typically tell everyone what your A1c is. I really find my A1c to be very personal and I don't typically share it with people outside of my husband, maybe my mom and of course anyone on my medical team. I'm thankful for Dexcom technology that is helping me get there. I can't wait for our family to grow, but I'm willing to wait it out until my body is ready!

Thanks again for all you do!

The bowtie. Be very suspicious....

You found a doctor that calls it YOUR diabetes?

He could be wearing one of those blow up sumo suits every day and I would still see him.

I think this post eloquently describes our real struggles with BG control. I've been a diabetic for 20 years, and always thought I was in good control. What I didn't realize was that the 100s and 120s I would see at breakfast and lunch was contaminated with a 250 post-prandial that I never saw. My A1c's have always been decent (6.5-7) but I didn't know it was due to severe swings, and not hanging in the 120s like I thought. After realizing this, I declared war on diabetes. Now, with a new medical team that gives a damn (unfortunately without a bowtie :)) and a few months with the dexcom, I still struggle with daily lows (in the 60s instead of the 40s) but have far fewer trips above 200. It's not easy, and I'll never be "done," but it just goes to show the benefit of active diabetes management. Thanks Kerri!

Think of the bow tie as a fabric mustache -- that slipped.

A bow tie is acceptable if it's real and not a clip-on! I've figured out why MY BGs are all over the place: sleep apnea. Despite this my control has been pretty good. I imagine that once I've got my CPAP that my BGs will even out even more.

I'm with alana. Any doc that guides you while understanding that this is YOUR diabetes could show up in a tutu!

That's awesome! But I have a question: how come you went to a see your PCP to talk about your diabetes lab work? I always just go to my endo for that. In fact, I don't even have a PCP! Just an emergency clinic across the street should I need anything urgent. Just wondering what services the PCP provides that the endo doesn't. :)

Found this article more interesting to learn about pregnancy and A1C. Never knew about all the lows (bowls of cereals and still a low!). Isn't it annoying when you feel like you 'over estimate' or eat a 'no carb' meal and end up high?

Don't know that many diabetic girls. Interesting to learn about the differences between male and female type 1s. Keep up the good work. College with diabetes means A1C anywhere in the 7's is happy enough. A "normal" day doesn't come often.

Katy - Now I'M picturing him as Al Franken!

Nikki - I LOVE THAT!!

Allison - I see my endo every six months and my PCP every six months. A1Cs run at each appointment. But I wanted someone local (my endo is at Joslin) to handle things like sore throats, ankle sprains, etc. There's more than diabetes in play when it comes to my health. :)

I'm going to vote in FAVOR of the bow tie guy. In my experience, bow tie wearers tend to be a little bit nerdy in all the best ways. (Full disclosure: my husband wears bow ties sometimes.....he's kind of a tie-hound.)

My consultant wears a bow tie and he is awesome! So I vote that you just go with the whole bow tie thing. Wear one next time you see him - really get on board.

And of course, thumbs up for the A1c happiness!

"imitation is the best form of flattery"
next visit, wear a bow tie......=)
Great work on YOUR diabetes

I just found your blog and really enjoyed reading some of your posts! I am a type one as well. Congrats on the good bg! I am voting in favor of the bow tie; bow ties are cool!

Yay for a good doc and a good A1C!
I've known a few bowtie wearers. They are very nice, smart people. I call them my friends.

BOW TIES ARE COOL!

/obligatory Doctor Who reference

The guy's a keeper.

Bow ties are a lot like mohawks, in that the wearer is saying "This is how I like to look, and I don't much care if you like what it says about me or not!" I'd never be able to rock a bow tie. :)

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