Since transitioning to the Omnipod 5 roughly 8 months ago (and obtaining a deeper understanding of how the algorithm works), I strongly suspected that I would be pleased by the results of my next A1c reading. What I did not expect that it would be my best reading in four years – maybe even longer than that, if only I could see my results dating further back!
While I’m not going to share the exact number here, for reasons I’ve written about in this past blog post, I am writing about this little victory of mine because I needed to take a moment and reflect on how far I’ve come in my diabetes journey. For many, many years, I rejected the notion of diabetes technology. I was stubbornly resistant to exploring it whatsoever, likely out of fear that the change would have negative consequences on my health or standards of living. While I wish I could go back in time and encourage my younger self to give it a chance or explain how it would benefit me, I’m just grateful for the fact that I did eventually come around to trying it and realizing how much it changed my diabetes care and management for the better.
Don’t get me wrong, I’m still very much a proponent of time in range compared to A1c – and I’m thrilled to report that my time in range has also significantly improved since I switched to the 5. But for me, I can’t help but attach some extra value to my A1c, maybe because it was the standard measurement of diabetes “control” for most of my life with diabetes so far. So it feels really good and natural to celebrate my latest A1c achievement.
“A1c: Also known as Hb1c or hemoglobin A1c, this is a test that is conducted every 3 months (or as requested) by an endocrinologist. A patient gets blood drawn to determine the average amount of glucose concentration in the blood during that 3 month period. The result of this test is a percentage amount, with 5% being an average result for a non-diabetic individual.”
This is the definition of A1c that I’ve shared in the diabetes dictionary section of Hugging the Cactus, and while of course the meaning and purpose of an A1c test will never change, one thing certainly has – and that’s the question of whether or not it’s the gold standard metric that indicates diabetes management.
That’s because A1c has a little competition called time in range. The concept is exactly what it sounds like: It’s an indicator of the amount of time a person with diabetes has their blood sugar within their preferred range, and it can best be captured by a percentage (e.g., I spent 70% of my day yesterday in range, with 30% of my readings either lower or higher than my ideal range).
While these two metrics vary from one another in how they are captured and analyzed, they do have one thing in common for a person with diabetes…is it a data point to share with others outside your healthcare team, or is it something to keep to yourself?
To share or not to share A1c and/or time in range…that is, indeed, the question.
The answer is personal and unique to every individual with diabetes, and for me, I keep it to myself in both cases. I’ve never felt comfortable opening up about my A1c or time in range online or in person. I think that’s mostly because I struggle with comparing myself to others. I do my best not to, but I can definitely turn diabetes into a competition that I internalize at all costs because I don’t want other people to know that sharing about these data points makes me deeply uncomfortable.
It’s how I am, how I’ve always been, and likely how I’ll be for quite some time. I’m curious to discover whether or not starting the Omnipod 5 will impact that at all, seeing as I have high hopes that the system will greatly increase my time spent in range as well as lower my A1c. But for now, I’m content with keeping these diabetes numbers to myself, and will aim to get better about telling people that I prefer not to discuss either.
I read those six words, all strung together in a terse message from my doctor’s office.
Not exactly the response I was anticipating when I reached out to them to express concerns over a minor health issue I was experiencing…
Let me back up a bit. In early January, I decided to message one of my doctor’s to discuss said minor health issue. A week went by and I didn’t hear anything from them, so I sent them another message, reminding them gently that I was hoping for a reply sooner rather than later. Several more days pass by and I start to get annoyed, but I still keep everything in perspective: Maybe they’re understaffed at the moment. Perhaps a computer error prevented them from getting my messages. Or they might be just crazy busy with beginning-of-the-year appointments and responsibilities. Whatever the case may be, I decided to message one more time, drawing attention to the fact that my first message had been sent two weeks prior and that if I didn’t hear back by the end of the week, then I’d just call the office to hopefully connect with a nurse.
Luckily, it didn’t come down to that because within 48 hours of me sending that third message, I finally heard back from someone. And this someone said something that left me a bit gobsmacked:
“…with an A1c of 7 – you need to be better with your control.”
I couldn’t believe what I’d just read, for multiple reasons. For starters, I’d mentioned in my first message that I *think* my A1c was right around 7, but I couldn’t be sure because it’s been a bit since I last had my A1c checked. So clearly, by reading the response from my doctor, nobody had gone in to check my records or look up my historical A1c – which may or may not have provided them with better context so they could answer my question better, but that’s besides the point. What had me most irate was the fact that I’ve been told – time and time again – that I’m doing a great job with an A1c around 7. I’ve had endos and nurse practitioners alike tell me that I don’t need to make any major changes and that I’m too hard on myself when I express a desire to get a lower A1c. So to have a completely different medical professional make a snap judgment right then and there that implies I do not have control over my A1c is obviously in direct conflict with what I’ve heard from others. How maddening is that?
Furthermore…I’m sorry, but A1c does not paint a complete picture of my “control”. I believe, along with many other people in the diabetes community (including medical professionals) that time in range is where it’s at. The amount of time I spend in range is leaps and bounds better than where I was in college – and honestly, so is my A1c.
This is why it’s incredibly frustrating to me that this person handled my health issue as though it was directly related to my diabetes and their perception of my lack of control. The three-sentence, curt reply to my initial message didn’t exactly help matters either, though I’m trying to not read too much into that…after all, you can’t gauge tone via written message.
I’ve decided the best way to handle this whole exchange is to bring my issue up again when I see this doctor later in the year. I’m not going to reply in the message thread, because I don’t see how that would cause any good, but I will bring this up when I go to see the nurse practitioner at my endocrinologist’s office at the end of this month. While she likely can’t fully help me address my health concern, she’s bound to provide me with some insight and some actual helpful advice that won’t involve her jumping to conclusions about my control. We’ll see how it goes.
For now, I will just have to try to keep my head held up high by taking control of the situation, if not my diabetes.
Before I left for my vacation, I had my (long overdue) annual physical with my primary care doctor. Like he does every year, he ordered bloodwork for me which meant that I had a whole host of health data to review on my online patient portal, including my current A1c.
When I saw that value up more than half a point from my last reading, my heart sank.
Now, I’m not going to say specifically what the reading was, because I’m a strong believer in keeping that sort of information to myself (and if you’re the type of person who shares their A1c, that’s okay, too – it’s just not for me). But I will say that it definitely isn’t the worst A1c reading that I’ve ever had, though it upset me because I think it’s the highest I’ve been since my college years.
Once it fully sunk in that this was my current A1c reading, like it or not, I started thinking about the why. Why have I gone up? I could think of a few factors…
I haven’t been eating super healthy; rather, I probably eat too many sweets that cause my blood sugar to fluctuate more than it ideally should.
The pandemic has changed a few things about my daily lifestyle – I don’t get out of the house as much I used to because I work from home, which means I’m in very close proximity to my kitchen and that gives me too many opportunities throughout the day to snack.
I get lazy and don’t bolus for “small” snacks (i.e., snacks with 10 carbs or less).
On the subject of laziness, I’ve been really bad about “eyeballing” my plates and portions lately when it would obviously behoove me to measure out my food and study my nutrition labels.
So those are the things I could think of that are the likely culprits behind my dissatisfactory A1c. As I sat and stewed over them and chided myself for my carelessness, though, I also tried to gently remind myself that A1c is only one measure of blood sugar “control”: I told myself that I need to bear in mind that my overall time in range is something that I should study and try to learn from, rather than dwell on this narrow snapshot of my 90-day blood sugar averages.
Using my Dexcom Clarity app, I learned that my time in range was suffering. I prefer to spend 80% of my time in range, and lately, I’ve fallen short of that goal. So after studying the amount of time that I spend “high” or “very high” (high blood sugars are always more troublesome for me than lows), I started to get a clearer picture of what was going wrong for me and what I might need to do to fix it.
This whole exercise, as bummed as I was to have to go through it, is going to serve as a great reminder to me that whenever I get disappointing news about my diabetes management, the best way to cope with it is to study the facts that I quite literally have available to me at the tips of my fingers. I know why my A1c is where it is, and I also know now the areas in which I need to improve. And that’s something to be grateful about and use as a motivator so that I can improve both my A1c and my time in range.
I know I can do it – I’ve done it before and can’t wait to feel that triumph over my diabetes.
Time in range versus A1c…which measurement matters more when it comes to T1D care and management?
Well, I’m not exactly in a position to answer that, because I think the answer is unique to all people with diabetes. But I can explain what exactly both of these numbers are and how I view them.
A1c: Also known as Hb1c or hemoglobin A1c, this is a test that is conducted every 3 months (or as requested) by an endocrinologist. A patient gets blood drawn to determine the average amount of glucose concentration in the blood during that 3 month period. The result of this test is a percentage amount, with 5% being an average result for a non-diabetic individual. I consider the A1c result to be highly personal, so I don’t often share mine with others; however, I do refer to it when describing ways in which I want to improve my diabetes care and management.
Time in range: This value describes the literal amount of time that a person’s blood sugar is in “range” for a given period of time (e.g., one day, one week, one month, etc.). “Range” refers to above a person’s low threshold and below a person’s high threshold. One person’s defined range may vary greatly from another person’s, but for me, I have my low set at 80 and my high set at 180 on my Dexcom. In a perfect world, my range would be more like 80-120, but I have a higher threshold set to minimize the number of alarms that go off.
So really, both are just two different ways of measuring blood sugar performance over the course of certain time frames. And while I try to bear in mind that these are both simply numbers that help me see part of the diabetes picture, and not sole indicators of how “well controlled” I am or am not, I do pay special attention to them and have certain goals for myself. (I strive for an A1c of under 7 and I like my time in range to be at least 75%: These are goals I came up with independently, without my endocrinologist’s feedback, because it’s what I feel comfortable with when it comes to my diabetes…other T1Ds feel differently, and that’s totally okay!)
It’s important to me that I remember that my “success” as a person with T1D is not defined by either of these numbers. In fact, I know many other T1D individuals feel the same way that they should be viewed as signposts along the road to achieving desired diabetes results. It can be hard to do, though, because of how much weight is placed on these numbers by medical professionals and from people across the Internet.
The bottom line? I try to tune out the background noise and focus on taking it one day at a time. By no means am I perfect, but nobody is, and I know better than to put pressure on myself to strive for perfection. Instead, I do the best that I can to maintain my A1c and time in range goals, while doing everything I can to keep the bigger picture in mind instead of individual numbers.