“I’m surprised it’s not any higher. You cannot have your cake and eat it, too, you know.” That was my husband’s reaction to my latest A1c* number. My own reaction was no different – a combination of relief and self-admonition. [* “What’s an A1c?” Please scroll down to the end of this post for a brief answer.]
If I tell you what my A1c is, you’ll probably object to our reaction because my number is fairly acceptable. But the number by itself does not tell the whole story. While it tells me and my doctor how I did in the past three months, it does not reflect the history of my A1c, which was lower in January and much lower in October last year. It does not show you the rising trend in my A1c. It does not tell you that I’ve been pretty slack regarding my diabetes control since October and certainly more slack in the past three months.
Rising A1c? Yes, that can be worrying. It may be an indication that my diabetes is progressing, or that I’m suffering from some unknown infection which keeps my BG generally high, or that I have to adjust my metformin dosage or try a new medicine. In my case, however, the answer is none of the above. My rising A1c is due to a far more common cause: slipping diabetes control.
Yes, I became far too relaxed after seeing my enviable A1c last autumn. In fact, I was so lax that even my husband, who sometimes cautions me about being too inflexible or strict about my diabetes control, noticed my laxity.
- Work-related stress
- Bad eating choices especially when working through lunch or dinner
- Irregular eating time, including late night after-work dinners
- Disappointment at not being able to run the marathon I trained for
- Lackadaisical attitude
Like many people, I tend to toss healthy habits out the window when faced with any type of stress. Healthy eating was the first to go. Then, I developed stress issues on my feet during my marathon training, so much as that I could neither finish the training itself nor run the race. At the same time, I became less inclined to test my BG regularly. It started with “Well, I had late dinner last night, was tired and slept late. I already know that my fasting BG will be through the roof, so why bother to check?” At the same time, I was telling myself that I could easily go back to my former discipline. But I had no strong incentive to correct bad habits because my A1c last autumn was so good. The two or three days of conveniently forgetting to check my BG became habitual. I snuck in a test or two once in a while but this became the exception, not the rule.
The good news is that I can do something about it before I completely lose control. I have my endocrinologist to thank for this. He is relatively accommodating when it comes to my diabetes treatment but not my regular A1c tests. I’ve tried renegotiating the frequency to once or twice a year to no avail. Now, I am thankful that he insists on seeing me every quarter. If not, I could have gone on longer in deceiving myself that I still have full control over my diabetes even when the reins were clearly continuing to slip out of my grasp. This incident reinforced the importance of regular A1c testing. Not only does it allow me to quickly nip bad habits in the bud but it also gives me a more accurate picture of how I’m actually doing. If I had my A1c tests once or even twice a year, then I would not be as aware of the changes in my body.
Hence, now I am happy to show up at my doctor’s clinic every three months. No matter how I look at things, quarterly A1c tests are necessary, useful and good for me. But these tests will be useful only if I reorient my behavior and habits as dictated by the results. My goals right now are one, not let my A1c go any higher; and two, bring my A1c down to a level that I find more comfortable. That means going back to a healthier diet, resuming my exercise routine, taking my meds, dealing better with stress, and most importantly, going back to my regular BG self-testing.
Before I end this post, let me just quickly explain HbA1c to my non-diabetic friends. HbA1c or A1c, short for hemoglobin A1c, shows the average of one’s blood sugar control over the past three months. If our blood sugar is too high and builds up in our blood, it binds with the hemoglobin in the blood, resulting in what is called glycated hemoglobin. The average amount of sugar in our blood is measured by measuring our HbA1c level. Hence, A1c gives a general picture of our average blood sugar control over the past few months. I personally aim for an A1c in the 5% range, preferably somewhere in the middle. Let me be clear, however, that this is just my personal goal, and I’m not telling anyone to adopt it. The American Association of Clinical Endocrinologists recommends an A1c of 6.5% or lower for healthy diabetic individuals who are not pregnant, do not have any concurrent illness and are not at risk for severe hypoglycemia. I urge you to read the AACE’s diabetes-related guidelines and treatment protocols for more information.
If you find regular A1c tests inconvenient or feel queasy about getting these tests, please reconsider. Regular testing may be helpful in your fight against diabetes.