21 August 2010

A1c - at what level?

We all have different ideas about the level of HbA1c we should maintain. For many of us with type 2 diabetes, the ideal A1c is only a dream of days gone bye. The American Diabetes Association (ADA) says that for those of us with diabetes should stay at or slightly below 7.0 (or estimated average blood glucose readings of 154). For few, this is not even attainable.

The American Association of Clinical Endocrinologists (AACE) says that we should be at 6.5 or slightly below for our A1c (or estimated average blood glucose readings of 140). For this I say thank you. At least they are lower than the ADA, which is another reason for my not feeling good about the ADA.

For me they are both still too high. My personal goal is to have an A1c of 6.0 or less (or estimated average blood glucose levels of 125). No, this is not ideal, but if I can maintain this or less, then I will have fewer episodes of hypoglycemia and far fewer episodes of hyperglycemia.

Every person needs to determine where their comfort zone is and strive to maintain it. If it is lower, then good for you. I understand the medical reasons for some people needing to have higher A1c's, but I do take issue with the medical community for discouraging those of us that want to be lower, and are able to maintain the lower levels safely.

I do tell my endocrinologist to forget it when she says I am too low at 6.0 or lower (5.6 has been the most recent lowest). Yes, I have been above 6.5 (A1c), but lower than 7.0 and the endocrinologist was happy. I finally explained to her that her happiness was not that important to me. It was how I felt about my goals and keeping them, that is what makes me a happy person. She does not have diabetes and I told her that a higher level would only serve to increase the arrival of complications sooner and that I did not want that.

I have not have any severe hypoglycemia episodes which have kept me from taking care of the corrective actions. I have been below 50 (BG) three times and below 45 one of those. I don't get concerned about readings above 64 as I want to be in the 70's and 80's when possible, which is not that often. A fasting 80 blood glucose reading is equivalent to an A1c of 4.4 which for me is more on the unattainable side. It has been a goal of mine to be nearer to an A1c of 5.0, but I am slowly realizing that my safe area is between 5.5 and 6.0. A few years ago, I think I should have worked harder to have gotten to 5.0. However, with age, has come the realization that living on the edge is not for me.

This blog also caught my eye as it is another persons opinion of their goal and what it should be. Even if we are different, I still have to respect her views.

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