Learning to Love a Slightly Higher HbA1c (Part 1 of 2)

I’m between my quarterly HbA1c readings. OK, wait. I just realized that my first sentence this week is kind of a “Duh!” introduction. I mean, that sentence will be true for the rest of my days. I am always between my HbA1c — except, possibly, for that brief moment every three or four months when I’m having my blood drawn for an HbA1c test.


Oh, I see I’m about to go off the rails here, because I want to spend my blog-entry word allotment on wondering just what separates one HbA1c reading from the last: When I enter the doctor’s office? When I have my blood drawn? When the sample’s in the machine? When the HbA1c numbers output to the nurse? When my doctor tells me? When?

But you know what? That doesn’t matter one bit. It’s me being me. But let’s leave those questions for someone much more intelligent.

What matters is this: My average blood glucose readings from my daily checks, according to my meter, have been higher this summer. See, since my May HbA1c reading, I’ve slowly and consciously allowed my average blood glucose to run a bit higher than in the three months before my last visit to my endocrinologist. Why? Allow me to speculate.

My January 2010 HbA1c was 7.0%. My May HbA1c: 6.6%. Great trend, right? During a difficult four-month period, a time when I was going through recovery from a thyroidectomy, and about a month of miserable hypothyroidism, I brought my numbers down. That’s all well and good. It’s what I want. Right?

In the three years since I started life as a Type 1 diabetic, with an HbA1c of over 14% at the time, the way I thought about those numbers before the percent sign was to get them as low as I could as quickly as I could. And diabetes media only reinforced my thinking. Aim for a lower HbA1c! It almost felt like a competition. Some athletic contest. Wear your numbers with pride. Push to see how low you can go.

See, I wasn’t alone.

“I’m at 5.5%,” a blogger would post. “I got mine to 5.7%,” another would write on a Twitter feed. “I’m going to shoot for low 5s!” from somewhere else.

There the chants of support from the galleries, comment after comment on popular diabetes blogs extolling the hard work for those persons with diabetes who get their HbA1c numbers that low. Heroes!

Then you also have those writers of blogs slightly higher HbA1cs who worry about their numbers in every third post, who consistently write about an elevated HbA1c as if it’s an albatross ’round the neck. These people receive oodles of support from fans who encourage the higher HbA1c-ers to keep trying, to get that A1C back down around 6%.

My endocrinologist, to his credit, during the many times we’ve discussed HbA1c, always explains why numbers somewhere between 6% and 7% are just fine, and why aiming for something lower than 6% doesn’t really make sense. At least, not from his perspective (the dangers of hypoglycemic episodes when one keeps the blood glucose low enough to achieve those numbers versus the added benefits isn’t really worth it).

Before I break off with this week’s entry and leave you salivating for the “Why are you speculating you went higher this summer? Get to the meat of this entry!” let me say that I’m not advocating one way or the other. I’m not a doctor. I’m not up to speed on everything written by experts. I’m one little ol’ blogger writing about himself with diabetes. I’m probably writing this entry because in the spring, one of the things that started to chip away at my “lowest is best” HbA1c mindset — for better or worse — were the reports that came out about higher HbA1cs being healthier.

I mean, come on! Can’t you cut a person with diabetes a break and let me know what shoot for?

Next week I promise I’ll delve into my summer blood glucose mindset and share with you why higher’s been, if nothing else, happier-making.

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  • Deb

    A new picture! Was it something I said?
    My A1C was higher and I’m not worried about it yet because it’s 7, but I did feel a little bit of pressure from my doc. We’ll see what happens….

  • Angela Norton

    A1C is just a number; a guide, but tells us little about the daily challenges of living with diabetes.
    I too allowed my A1C to come up a little, for a while. My 32 years with type 1 diabetes in varying control, but over recent years, tight control, had led me to no longer feel symptoms of low blood sugar until at a dangerous level.
    I set all my goals on my pump higher, and yes my A1c came up from 6% to 7% with no apparent problems except a general feeling of having less energy (perhaps related to my mindset). My sensitivity for low blood sugars came back, even alerting me to a blood sugar that was normal but on a rapid decline.
    I am back at 6.1% again, feeling better, and able to sense MOST hypoglycemic events, but I tread very carefully and will once again allow my numbers to come up if I start getting more hypoglycemic unawareness.
    My advise is to check your sugar frequently and adjust as needed and if your A1C is getting much too high, take a long hard look at those numbers because long-term problems may bite you later.

  • Rob

    In my mind, the A1C is a barometer as to whether I am even trying to keep some semblance of control. My reading has been right at seven for years, and my doctor shares my lack of urgency to lower it.

    I am a highly active individual, and trying to push my A1C down means more frequent hypoglycemic episodes. Since my hypo symptoms tend to be pretty severe, this causes me to overindulge in sugary foods for proper corrections. This in turn means extra pounds on my body which fights against my efforts to control my blood pressure.

    When you get down to it there are guidelines, and then there is the place that leads each person to their most healthy outcome. I say that if you can live with life in the 5’s, more power to you, but as long as you are better off in terms of your overall health what does an extra percent on an A1C really matter?

  • John_C

    The current best wisdom is an A1C as close to normal as possible (around 5). It’s only an average after-all.

    Probably more important is a blood glucose reading before meals, and after, as close to normal as possible…. to avoid the roller-coaster effect, which doesn’t always show up by looking just at an A1C.

    Sure does help with the long term complications caused from Diabetes. Tight control becomes habit after a while. Most common “recommended” diets however will not let you obtain the desired goals.

    I tried being more conservative for a while and experienced the return of some nasty complications. Of course insulin is a must to achieve meaningful results.

  • misskitty3

    I am shamed! For the last 3 yrs, my A1c hovered around 10.2. the highest it been is 11.5. The lowest it’s been in 3 yrs is 9.9.
    I’m encouraged that if I get it lower my low sugar warning signs may return. I carry a gluc pen because I feel the shakes, I’m usuaaly in the 40’s. Lowest I’ve gone is 26mg/dl. Scary, isn’t it?

  • Cathy A,

    I have mine down somewhere in the 5’s, but it’s time to do it again in a few weeks. I always go up in the summer too, but that’s because I love the bounty of summer and eat a LOT of fresh fruit and veggies. Can’t keep away from the peaches, cherries,and corn on the cob!