Diabetes Self-Management Blog

A couple of weeks ago (in "Am I Doing Fine, Really?"), I wrote about my visit to the endocrinologist and the results of my hemoglobin A1c test. With my latest HbA1c at 6.9%, I’m not dejected, complaining, or worried. And yet, this latest reading was my highest since my first reading three months after I was diagnosed with Type 1.

The results of my HbA1c test two weeks ago were, small as it may seem, a marked increase over my previous four or five HbA1c readings over the past year and a half. So I’ve been trying to determine some of the easy little things I could do to bring my HbA1c back down.

I’m sure many of you have seen the equivalency charts for mapping HbA1c levels. It’s often a simple three-column chart to show you “if your HbA1c is this” then your blood glucose in mg/dl is “x” and your blood glucose in mmol/l would be “y.” These charts are on the walls in my endocrinologist’s office; I received several while going through my diabetes education course; and they exist in various forms across the Internet. (The most up-to-date chart and online calculator, which translates HbA1c into “estimated average glucose,” or eAG, can be found at www.diabetes.org/ag. You can learn more about eAG in the blog entry “What’s Your eAG? You’ll Know Soon…”)

When I look at my HbA1c without giving the chart much thought, it’s pretty easy for me to say, “Oh, well, I was at 5.9% last summer, and now I’m at 6.9%.” And I think, “This isn’t that drastic of a shift.”

Yet, when I look at the chart, a jump from 6.0% to 7.0% is an average blood glucose shift of 126 mg/dl to 154 mg/dl. And that, dear readers, is something that spooks me a bit, and it has given me pause to reconsider where I’ve veered from my lower HbA1c ways.

An area in which I’ve slacked pretty significantly these past four months or so? Monitoring my blood glucose. Now, it’s all relative, so please note that these are my numbers, not yours; maybe you check more than I do, maybe less. It’s up to you, your endocrinologist, and your — sad to say — insurance coverage or financial situation to determine if you’re checking your blood glucose enough.

But I wasn’t checking enough. My prescription calls for ten blood-glucose checks daily. That’s a lot of test strips. Often, by the time I’m ready for a new shipment of durable medical equipment (infusion sets, sterile wipes, insulin reservoirs, test strips), I’m down to only a few remaining boxes of test strips (50 strips per box).

During the middle of last month, however, when it was time to assess what I would need for my next shipment of supplies, guess what? I still had at least a dozen boxes on my closet shelf.

My insulin pump keeps a 30-day history of my blood glucose readings, which I check every week or so. When I looked at my average number of bg checks over the past 30 days, it was around 6. That’s close to half the blood glucose checks I was performing when I had a really good HbA1c. And I’d really barely noticed the decrease in checking. Skirt the after-lunch bg test because I’m busy; avoid the morning check because it’s not going to be that different this morning than yesterday morning…and so on. They add up.

Correlation, then, in my increase in HbA1c? You bet.

Since my last visit to the endocrinologist, I’ve been more diligent about monitoring my blood glucose, not slighting the first check when I wake up, nor the all-important check two hours after a meal. I’ve even been getting up a few times in the night (bathroom break), and before I head back to bed, I make it a point to check my blood glucose.

Over the last two weeks, my average blood glucose has been around 117 mg/dl. And the only thing I’ve really changed is the number of times I monitor. Simple, yet effective.

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Comments
  1. Dear Eric.

    You have identified the single most important thing a diabetic can do that is to test often. The only problem is at 80 cents a piece in mostly after tax dollars it is quite expensive for people without coverage. Government here thinks it is cheaper to do foot amputations and by pass surgery than to subsidise strips.

    Posted by CalgaryDiabetic |
  2. Dear Eric.

    Just to follow up I just read on the Tudiabetes site that the Australian Govt lets all diabetics buy test strips a AU $2 a box of 100.

    This is a money saver in our state here in Canada called Alberta they prefer by-pass surgery, foot amputations and paramedic and ER stays to fight highs and lows at taxpayer expense.

    My Endo said that a paramedic intervention with a typical 1 1/2 day stay in ER to treat a nightime low costs our Govt at least $6000.00 which could pay for 10,000 test strips. Unfortunately our minister of health is too obtuse to understand simple economics.

    At least in America you can let your uninsured die without cost to the taxpayer or am I wrong?

    Posted by CalgaryDiabetic |
  3. Hi Eric,
    I test a lot and sometimes I have the feeling that my frequent testing is done simply to find out if the pump and infusion set is doing what it’s suppose to do (deliver insulin to keep my blood sugar under control) and not to find out how I am doing.

    I learned from experience to test every hour or two after a set change to make sure that my infusion site cannula is in the right place. Its amazing how fast and how high blood sugars can go when no basal insulin is getting into the body.

    Posted by Florian |
  4. Eric, I wish it were that easy for me, but perhaps it will be soon. I got on CGM about six weeks ago after a disappointing a1c of 7.3. I found that a lot of it was from rises that began sometimes 4 hours after a meal, though I don’t have digestion problems. Some foods take longer to turn to sugar than others. That said, I do need to regulate my diet better. I eat good food, but need better discipline. When I eat a lot of vegetables and fiber, my BG is much flatter.

    For now, I know there are times in the days and food choices that require that I use a square wave or dual wave bolus. Also, weekends, when I am far more active, I consume more than 50% less insulin at about the same carb level.

    –Peter
    p.s. A pump without CGM is a little like a computer without the Internet. At least if you are like me and are still grappling for optimum control.

    Posted by Peter Mead |
  5. How can you say, “And the only thing I’ve really changed is the number of times I monitor. Simple, yet effective.”?

    I don’t see how simply taking blood samples will change your blood glucose one bit.

    Please explain the science behind this for a relatively newly diagnosed type 2?

    Posted by cartunes |
  6. Cartunes,

    I can say it because it’s true. It’s a gateway into better care (and a reductive statement made in the writing of the blog as sort of tongue-in-cheek based on what I’d written prior to those last few words).

    So, the science behind checking as a way to change bg numbers is, I would venture to say, behavior modification. The blood samples themselves obviously don’t alter my blood glucose, but the act of taking the blood glucose reading and correcting or altering what I’m doing accordingly, does make a difference. I’m insulin-dependent, type 1, and therefore have control over basal rates, bolus ratios, not to mention the food and drink I put into my body. So, yeah, that’s my quick two-minute answer.

    Eric

    Posted by Eric |
  7. When checking your blood glucose after a meal do you check it two hours from the time you begin eating or when you finish the meal?

    Posted by Marcille |

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