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A1C Mismatch

By Scott Johnson

If you are not familiar with the A1C test (now the EAG), you should be. This is a very standard lab test that is used to measure an average of your blood sugar over the past three months. From what I understand, in layman’s terms, the laboratory is able to take a look at a blood sample and measure the amount of sugar that has stuck to the red blood cells. From that test they are able to estimate your average blood sugar for the past three months, which is the normal life span of a red blood cell.

Averages can be misleading. It is entirely possible to get the same average many different ways. One way would be to bounce back and forth between the extremes (240 mg/dl and 40 mg/dl equals an average of 140 mg/dl). Another would be to have a rock steady blood sugar of 140 mg/dl all the time. Which is healthier? I think the steady 140 mg/dl is healthier. Standard deviation is a number that measures the “bouncing.” An in range average with a low standard deviation is a lot different than an in range average with a high standard deviation, even though the average is the same! The A1C test does not take into consideration the standard deviation. It is all averages, all the time.

I get the results of my A1C tests at my quarterly endocrinologist appointments. I always experience a lot of anxiety leading up to hearing the results. It is very weird to have the past three months of struggle squeezed into the few seconds it takes the doctor to read the number. I’m often paralyzed by a whole bunch of emotions, ranging from guilt and anger to downright disbelief. The results almost never match up with how I feel I’ve managed my diabetes over the past three months.

When I feel I have done really good, and expect a lower result, it has many times actually been higher. I can’t find the words to describe how damaging this is for me. I often experience raw disbelief, then a bunch of anger, followed by guilt and doubting myself, then a defeated sense of acceptance and feeling that I have to work even harder, which seems downright impossible.

When I feel that I’ve been running higher, and expect a higher result, it has many times been the same as last time or even lower! This is a tricky one for me. If it is lower than last time, the positive feedback from the doctor is oozing from the walls (and who doesn’t like positive feedback?). Then I wonder if he has the right chart, or if he’s looking at some other “Scott Johnson”? Then there is often a tainted feeling of accomplishment; maybe I hadn’t been doing as bad as I thought. I might wonder if I was low a lot, bringing that average down, even though I saw a lot of high blood sugars too.

After I’ve dealt with the emotional fallout, which takes anywhere from a few days to a couple weeks for me, I still need to figure out what I am going to do next. How am I going to improve my diabetes management? What can I work on that will help me manage my diabetes better?

In the end, the A1C test result is just another number. It is a number that can be affected by all of my highs and lows. It is a number that will not always accurately reflect my efforts, and I need to keep that in mind. What is most important is feeling good and doing my best to stay in range as much as I can.
 

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Disclaimer
dLife's Daily Living columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team to find out what will work best for you.