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Checking, and Checking Some More

Eric Lagergren

February 5, 2009

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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