Diabetes Report Cards
Quest to pass A1C test too often resulting in emotional standstill.
By Kerri Sparling
March 2007 — I can't figure out what my hang-up is about this test.
I test my blood sugar anywhere from 10 to 18 times per day. I'm completely neurotic about it, since I experience some hypoglycemic unawareness that lets tricky lows sneak up on me occasionally. I am also on an insulin pump, taking care to tweak my basal rates, test my insulin to carbohydrate ratios, and spending all that damn money on pump supplies. I eat well. I exercise regularly. I stay on top of things as best I can.
But then there are those moments when I completely flake off. I indulge in the stash of peanut butter Hershey Kisses at the office. I find myself drinking foamy, high-carb chai lattes from the coffeehouse down the road. I'll blow off testing my blood sugar, or I'll bolus without carefully calculating my meal and end up plummeting into a nasty low blood sugar episode. These moments of "I don't want to do this anymore!" are irresponsible, embarrassing, yet seemingly unavoidable. I don't want to have my numbers bounce all over the place. I don't feel healthy and confident with those high blood sugar sweaters on my teeth, or that post-hypoglycemia headache. But I have a really hard time being "game on" at all times with my diabetes management. It's a disease that requires intense daily management, often causing me to navigate regular life occurrences with my meter reluctantly clutched in one hand and my insulin pump tethered awkwardly to my hip. There are days when I don't want to do this. And there are days when I feel so guilty. The guilt of those Hershey Kisses lingers longer than their chocolate taste.
Why do people speak so openly about the need for tighter control and low-carb meal plans, yet neglect to recognize that a confident emotional state is crucial to diabetes management? Mental well-being is what makes me want to test my sugar and exercise. It's just hard sometimes to keep everything under control. It's hard to muster up the desire to keep things under control.
And it's harder still to receive confirmation that your actions haven't been enough to produce what the medical world has determined good results: an A1c result under 7%.
I had an A1c under 7% three years ago, right after I went on my insulin pump. It was that "pump euphoria," where I was so obsessed with my new gadget and diabetes management was the biggest focus in my life. I raked in a 6.4%, dropping from a crispy 8.2%, so I was ecstatic. I posted this result on the fridge, for crying out loud. "I'm in control!" The guilt was alleviated, because this A1c, this diabetes report card, said I was doing a good job.
However, pump euphoria only lasts so long. It's like a new relationship – all elation at first but the spark dissipates after a while, leaving you still happy but adjusting to the comfort instead of the novelty. Diabetes went back to being a "part" of my life instead of the entire driving focus. My A1c slowly crept up a few notches, hovering just over 7% since.
I moved to a new town last July and had an A1c taken before I left. Let me clarify: I moved to a new town to work for a diabetes-related company. Wouldn't you think that working here would give me more of an impetus to have this test done? Unfortunately not. It's now been eight months, and it took me four cancelled appointments and three silly excuses before I mustered up the courage to have my A1c drawn. While I am scared of having blood drawn and reluctant to let anyone other than myself poke needles into my skin, it wasn't my fear of needles that kept me from having the test. It was more that I feel so judged by that number, as though it constituted my value as a person.
Ridiculous thinking? Yes, but so much pressure, stigma, and pride is placed on that one test result. It's always been viewed as the benchmark of my diabetes control. Even though I feel good about testing often and keeping tight tabs on where my sugars are going, that A1c result can blot out all of my good intentions and send me spiraling into a bad mood. So I avoid and postpone. What I don't know can't hurt me, right? Isn't that how that goes?
Not true. I need to face facts – this A1c result doesn't define my diabetes care. It's not indicative of how hard I'm trying, necessarily. It doesn't make me a success or a failure. It just needs to be done so I can better manage my diabetes.
I had my A1c drawn last Friday. I have no idea what it will be, but when I tear open the envelope to reveal the results, I won't take it as a strike against me. I need to know this result because then I have the chance – the power – to change it.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
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Well maybe not so much a furor as a controversy. The question, bluntly put, is whether or not a single HbA1c reading should be sufficient and adequate to diagnose diabetes — and whether the conditions under which the test was conducted should have any bearing on the diagnostic or non-diagnostic value of the test. The lede from