Failing the Hemoglobin A1c Test

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I feel like a failure. 

I got my latest blood test results yesterday and I was so disappointed with my hemoglobin A1C that I just can’t get over it.

After holding steady at 6.4% for the two previous blood tests, my latest result is up to 7%.

I know this is not a horrible result, and that many doctors consider a hemoglobin A1C of 7% to be in the norm for people with type 1 diabetes, but to me this feels like a huge personal failure.   And it wasn’t the only disappointing result I got.  Against my doctor’s advice, I stopped taking my statin.  The result was not what I had hoped for.  Without a statin my LDL cholesterol is up to 150 – fine if you don’t have diabetes, but far from the 100 result people with diabetes should have.

Had it only been my cholesterol that was high, I could have dealt with it.  It was my decision not to take the statins.  But I feel like when it comes to the A1c, I do everything I’m supposed to do.  I work ALL the time.  I’m totally responsible.  So seeing a significant jump in A1c put me in a bad mood, so bad I only started to get over it after a good run this morning.

I’ve been told many times and have told myself (and others) that I should not judge myself according to my blood test results. During my morning run I tried to convince myself of this repeating it in my head over and over again – you are not your A1c. It didn’t convince me of anything but the heat and hills did the job and at a certain point I just forgot all about my A1c and was left with my run.

A1c - an endurance sportI have to be honest and say that this result – despite my efforts – didn’t come as a total surprise. I had blood sugar control issues after my last marathon. Some had to do with not running and some with problems I had with my insulin pump and infusion sets, which resulted in days of high blood sugars. I also gave myself a bit of a break during the holiday, enjoying a matzo ball or two (what can I say I’m only human), but I checked my blood sugar.  I covered for the matzo balls.  I didn’t expect my A1c to be great or better than my last but I wasn’t expecting a 7%.

I take my A1c results seriously because although it doesn’t tell the whole story the hemoglobin A1C doesn’t lie. If I have an A1c of 6.4% it means my average glucose level for the last 2-3 months was 136 and if on the other hand my A1c was 7% it means my average glucose level for the last 2-3 months was 156. That is a huge difference.

But the truth is that my feelings of failure have much more to do with not achieving what I set out to do. It’s kind of like running a bad marathon after training for it for three months.

I wish I could say that the only reason I feel so bad about my result is because I’m scared of complications, scared of heart disease, blindness and all the other things. But that isn’t so.

Tomorrow I have an appointment at the diabetes clinic. I know I’ll get shit from the doctor. I can already see her looking at her computer screen and telling me “this is not good”.  No, I don’t care what she thinks but it will force me to think about my mistakes again – and feel worse about “failing”. Like having my nose rubbed in it.

But diabetes is a long ride, an endurance sport, and one bad result doesn’t mean much in the long run. So, here’s to a better result next time. 

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Comments (13)

  1. Sweets at

    New here :)
    I so get what you are feeling right now.  I had a similar result this week – up from 6.8 to 7.2, and while I expected it as I have been having some basal issues that I have been trying to sort out, it still came as a shock.  I get so nervous before getting my results; it practically feels like doing some big test/exam, and then getting the results for it.  And like you, I also try not to put too much into that number, but I have yet to manage that!  Sometimes I think I judge myself more harsh than my doc does – he is great, but this appointment did come with – we need to work on those overnight and morning basals to gets things back under control.  I have stayed below 7 for some time now – since before falling pregnant (my son is now 2.5), so seeing/hearing that 7 wasn’t good.

  2. Nathan at

    Michael, I can relate to you in this. For me, it is as much about having a goal and achieving it, than keeping complications at bay down the road. Sometimes, on the way to getting to a better place, we have to see what doesn’t work.
    For me, I often have a stretch with really good and easy control, and then when things go off I’m not entirely sure what changed. Sometimes months later I realize what really impacted my control the most.
    Lately, I’m noticing that consistent exercise makes me more insulin sensitive all the time, and if I get out of that pattern, I’ll see an overall change in my control. More insulin, higher BGs. 
    It’s not failure at all, it’s part of learning and it’s part of your motivation. If you didn’t care, it would be a problem…

  3. Mike at

    I am totally with you on this one.  I really beat myself up the last time I was at my endo when I saw my a1c result.  I actually asked the doc to run it again to make sure something wasn’t wacky with the test.  I beat myself up because I try my best day in and day out to keep my BS in a good range and when I see a surprisingly elevated a1c I feel like I’ve failed.  

    It’s like studying every day and night for a test for 2-3 months and getting a C.  You would expect an A, but sometimes there are questions on the exam you didn’t anticipate and prepare for.  Wish I was still in college!!!!

    Good luck on the next one and thanks for sharing. 

  4. Arthur at

    Here’s the thing, Michael: If you think about Diabetes as a test that you can prepare for in a uniformly consistent, quantifiable way, then you are setting yourself up for failure and frustration.  I think a more accurate model might be to think of Diabetes as an intimate relationship.  There are definitely things you can do to make a relationship work well: You can be considerate. You can be thoughtful. You can listen well. You can make sure that the relationship is always a high priority. (You can exercise, you can count your carbohydrates to the best of your ability, you can eat healthfully, you can try to manage your stress.) But a relationship is between two people, both of whom are human (i.e. subject to an infinite amount of variables in life.) You can not have absolute control over your partner. You can not ensure with absolute certainty that you will not have fights with your partner, that she or he will never be having a bad day, or going through a rough patch, etc. that will have an impact on how you relate on one particular day…or over the course of several weeks. 
    In the same way, your Diabetes is complex. I’m sure you work, have friendships, have a family, read the newspaper, react to the world…all of these things can affect your stress level, how much you sleep, the quality of your exercise, the food options before you (as you suggested when you mentioned the Matzoh Ball) etc.
    As in a relationship, all you can do is the best you can. And sometimes a higher A!C is an opportunity to see if there”s something you can change for the better (an eating habit, an exercise habit, etc.) Just as a fight with one’s significant other can be an opportunity to work out a problem.  But just as that single fight doesn’t mean you have “failed” your relationship, a single A1C in the wrong direction does NOT mean you have failed as a diabetic.
    Hang in there!!
     

  5. Sysy at

    I feel ya on this.  People often tell me why I ever worry about my A1c since it’s always below the recommended level.  But sometimes, I go off my healthy diet and feel like that is a big personal failure and though people comfort me the truth is that I really hold myself up to certain expectations and I feel badly when I let myself down.  Lately I’ve been so busy I’ve been missing the aerobic component of my exercise and my numbers are much more challenging to deal with.  I recognized recently that even though I may feel like I’m letting down my kids by going on a run each afternoon when my husband gets home, the truth is they need me to stay healthy and I need to do what I need to do.  Wow, glad I just figured out a solution to my problem lol…now to implement it and maybe not be so hard on myself…  You too, don’t beat yourself up, get into analytic mode and figure out what needs to be done.  You’re an inspiration to us with all you do and how you stay healthy!

  6. Eric at

    Michael,
    As an athlete I feel your pain. Working out is supposed to make all this T1 nonsense easier, right? Of course that isn’t always the case. And only recently have I even considered the type and volume of my training as a potential barrier to overall health.

    Athletic goals are fleeting and finite. You want your health to be infinite. That contrast can be a bitter pill to swallow. I know it has been for me. I had a real wake up call after reading Robb Wolf’s post on T1 and CrossFit. Give it a read. It’s not specifically about marathons, but the gist is the same. 

    I wish you well, however you decide to move forward. I have been in your shoes and know that each stride is supposed to bring us closer to our goals, but sometimes those goals and our disease just don’t fit.

    Eric 

  7. Jonathan Berman at

    Michael,

    My heart started beating double time reading this post….totally understand….and for me, running is the only time i feel I am getting even with Diabetes. Not much I can say that you don’t know….other than…keep running……. 

  8. Michael Aviad at

    Thanks to all for your long and interesting comments. 
    Now that a few days have past and my doctor showed no concerns about my A1c. I am over the failure feelings and back on the ball. I agree with arthur that the periodic A1c is kind of a reminder. a time to reflect and think about what I’m doing with my diabetes management – diet, meds and exercise.
    @ Eric, I know I would probably be better off running 7 miles a day instead of training the way I do. But I can’t do that. I need a goal, a mountain to climb. And I chose marathons (it would sound cooler to say they chose me but…). 
    Looking at the big picture I’m much better off living the way I do than letting my self go – not running on a regular basis.
    I have already chosen my next marathon and although not officially in training yet I feel a huge commitment to get in better shape which includes managing the big D.

  9. When I see my doctors and they assess my HbA1c – the first thing they do is download my all my CGM results to see what kind of excursions are taking place. (I wear a CGM 90% of the time).  They also download my BG meter to review those results.  If my variability is tight and my A1c is respectable than I am congratulated.  If there are many excursions (dropping or increasing by 100 or more or going from 80 mg/dl to 250 and back down to 100 again) then that is not considered indicative of control regardless of the result. It’s a controversial subject but averaging down below 7-6.5% with huge swings and variability is not healthy.  I am not assuming this is your case, but I believe the best academic or clinical docs think HbA1c’s assessed alone without reviewing the BG data behind the result is meaningless.  Achieving flat lines and stability mean much more than any average.  
    On a completely separate topic, you have been very outspoken about your Paleo diet and am wondering how you manage as a marathon runner to consume zero carbohydrates.  Other than burning fat and converting protein to energy, is it possible to perform? I guess I am wondering how sustainable or effective a zero to extremely low carb diet is for athletic performance?  Many thanks.  Elizabeth

  10. Michael Aviad at

    Hi Elizabeth,
    I have never been on a zero carb diet since there is some carb in most things. I do follow a relatively low carb diet. I don’t eat starch but I allow myself quinoa and before very long runs, like a marathon, I eat sweet potatoes (which is in accordance with Loren Cordain’s The Paleo Diet for Athletes).
    It is difficult to get enough energy for long distances without any carbs but for anything up to 10 miles it’s fine. I never tried to totally wipe carbs out of my diet but there are those like Peter Attia from waroninsulin.com who do it.
    As a person with type 1 I chose to go low carb because I found it helped me control my condition. I also believe than injecting small amounts of insulin is a safer and better way to manage type 1 diabetes.
    I read that you eat 40% of your calories from carbohydrates. That is relatively low and much lower than ADA recomendations. 

  11. Thanks Michael…I appreciate your clarification.  I am always interested in understanding how others manage.  With so many different formulas and ways of managing it’s so easy to second guess personal strategies and I am always re-evaluating.  As harsh as it may sound – ADA is not the gold standard in practice for me on T1 diabetes care (T2 for that matter either) and believe it or not – I have a great deal of trouble consuming 100 carbs a day – which my health team keeps banging me on the head about.  Best wishes for your upcoming race.  E. 

  12. Kitty at

    You feel scared. Everything will be all right.

  13. Gail at

    I have been diabetic for 61 years.  My BG readings not been the ideal even line, but the average and A1Cs have been very good, usually 6 or less.  I have minor neuropathy showing only as a little loss of sensitivity but no pain.  I think it has helped a lot that I have kept consumption of animal fats to a minimum and mostly avoided complex carbohydrates and sweets.  Just recently I started on an insulin pump and it’s making the control a lot easier without the long-acting insulin lurking somewhere in the works.  Best wishes to all who share this disorder and thanks to Michael  for this best of diabetic newsletters.

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