A1C

I’ve been having a lot of doctor visits and medical tests done in the past two months. December – 3 days in the hospital and 2 visits immediately after release; January – 7 visits/testing sessions; first week of February – 7 visits/tests (and at least 6 more in the remainder of the month). But I’d like to write here about the things that are more under my control, namely making sure I take the prescribed medications and the other foods/supplements that I eat. In particular, I’d like to focus on my diabetes and what changes I’ve made over the past several years to deal with it.

 

What’s an A1C?

One of the key measures with diabetes is checking your blood sugar levels. Levels that are too high can do damage to various organs. But levels that are too low are also dangerous. Either can lead to death. So it’s important to manage those sugar levels in your blood. But what do the numbers mean?

One of the most common tests is called the A1C. The CDC puts it this way: “When sugar enters your bloodstream, it attaches to hemoglobin, a protein in your red blood cells. Everybody has some sugar attached to their hemoglobin, but people with higher blood sugar levels have more. The A1C test measures the percentage of your red blood cells that have sugar-coated hemoglobin.”

Red blood cells have a lifespan of about three months. Therefore, when the A1C test is looking at those cells, you are getting an idea of the average blood sugar levels for the past 90 days or so. While the A1C result is reported as a percentage of those cells, it can also be reported as estimated average glucose (eAG), the same numbers that are reported when one does the typical “finger stick” and testing with a portable meter. But what levels in these reported results are “good” or “bad”. Here is one chart from the Cleveland Clinic.

As you can see, the various levels are colored green (OK, or “In-range”, <5.7%), yellow (prediabetes, 5.7-6.4%), and various intensity of red (Diabetes, >6.4%). The accompanying text also notes that “If you already have diabetes, an A1C results is a glimpse into how well your management plan has been working over the last three month. Management may involve oral pills, taking insulin, monitoring blood sugar levels and/or lifestyle changes, such as diet and exercise." I should also note here that the A1C is a 3-month average, so one person might have fairly consistent daily results whereas another person might have readings that vary widely. I know one person who has wild swings of the eAG with measurement of 50 then a few days later over 400! My results are pretty consistent.

 

So, how am I doing?

I was first tested for diabetes back in 2015 (8 years ago). My result was an A1C of 7.1, i.e. in the low diabetic range. Over the next nearly two years, subsequent tests gave increasing results in the 8.3-8.5 range. It was then that I was first prescribed some oral medication. My results dropped into the 6.2-6.6 range. Then they started climbing again. My doctor prescribed first higher doses of the same medication, then eventually additional drugs as well. I would initially respond well, then my numbers would start climbing again. By this time, I was also using a meter and finger sticks to check my levels daily. The meter would report things as “in range” when my results were 180 or below, and “out of range” for anything over 180. By 2021, I was taking the maximum dosage of two different drugs, but I was back up to the 7.5-8.0 range.

It was then that I was scheduled to meet with a nurse who specialized in transitioning patients to insulin. She started me off on a very low dose, had me check my sugar levels on a daily basis, and would check in with me every month and adjust the dosage higher until eventually I was getting readings that she approved of.

I should note that her “goal” for me was to have eAG readings in the 70-130 range, so as soon as I had a few readings in that range, that was the dosage she approved. I had started out with her in mid-2021 getting 3-day averages of 190-195. By October she had increased my dosage from 10 to 50 units each day and I was getting 3-day averages of around 120.

Unfortunately, the body adjusts to the dosage and it slowly becomes less effective. By the end of the year, I was getting 7-day averages in the 140-150 range – still a whole lot better than 190-195.

I continued to track on a daily basis for 2022. Whenever I had a reading that spiked over 180, I would think back through the prior day and what might have caused it. In May I bought some non-diet soda instead of my usual diet Mountain Dew. Wow, did I see the impact! For the better part of a week, my readings were 180-200! The same thing happened around Thanksgiving – having a piece or two of the pies that our family makes put me over 180 for nearly two weeks.

For 2023, I’m taking a more serious approach. And I’m happy to report that my 7-day average has stayed in the 130-150 range the entire time. I’ve also now recorded that if I forget to take my “night meds” (I take several pills each morning and just a couple at night) that my reading the next morning will be up about 30 points from the day before. I’ve only done that a few times, but sometimes life intervenes and I may have a meeting that runs long or a particularly stressful day and neglect to take those few pills. But seeing the higher results and a note “Forgot nite meds” on the log I keep is helping me to forget less often.

As for my A1C, I still get it checked a few times a year and I’m happy to report that my results have been under 7 since I began taking insulin back in mid-2021. My last two readings, including one a few days ago, were both 6.9.

Both the CDC site and the Cleveland Clinic site note that “The goal for most people with diabetes is 7% or less.” This recommendation comes from the American Diabetes Association. So while the chart above from the Cleveland Clinic shows that anything over 6.4 is in the “red zone”, as one who is attempting to “manage” their diabetes, 6.9 is absolutely fine with me. I will continue to monitor my blood sugars – both with daily finger sticks and with twice-a-year blood work that checks my A1C. But I feel that things are being “managed” properly.

 

Other medication/diet issues

I have two other medical conditions that also require paying attention to “managing” my medication/food inputs. One of these is going quite well, the other I need to begin paying attention to [again].

 

As I’ve reported previously on several occasions, I am working on getting a “hole” in the bottom of my foot to close up with skin grafts. To help speed the healing process, I have begun taking daily protein drinks. They appear to be helping quite a bit. My current efforts have resulted in the size of the hole diminishing by 2/3 in just two weeks. I’ve now put the protein powder that I mix up on a subscription plan (with Amazon.com) so I can keep it up.

 

Because of my focus on both the hole in my foot as well as managing my blood sugar levels, I have let one other area slide for a while. (I find it hard to pay attention to all my medical issues at the same time.) My cholesterol levels (HDL and LDL) have never been an issue. The only thing in my periodic Lipid blood tests that is “out of range” is my triglycerides. The expected readings are supposed to be <150. But my readings have never been anywhere near that. Back in 2016, my high water mark was 952! I began taking fish oil as a way of bringing down those results.

By taking a large tablespoon of it each day I was able to bring my results down into the low 300s. Getting any lower has proved next to impossible. A year ago I reached my low water mark of only 225. That’s still higher than recommended, but appears to be a reasonable level and I was quite happy with it. However, with the increased focus on my foot and all that was needed there, I have let my focus here slide. The effort of taking a liquid each morning as well as all my other medications (which are in pill form) was just too time-consuming with everything else I needed to do. My most recent lipid panel showed that I was back up close to 500 – certainly not the 700-1000 range that I used to be in, but it shows me that I need to add this area back to my daily concerns.

I’ve found a substitute (that was not available a few years ago) which delivers the benefits in a squeeze pouch instead of a bottle of liquid. It’s not only cheaper ($1.00/day instead of $1.50/day), but does not need to be refrigerated like the bottles of liquid need to be once you open it. So – cheaper, more convenient, and even more of the beneficial types of Omega-3 – I’ll take it! I’ve ordered a 3-month supply and I’ll then wait until my next round of blood work later this year to see what the impact will be.