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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13 Comments on "Failing the Hemoglobin A1c Test"

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Gail
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… Read more »
Kitty

You feel scared. Everything will be all right.

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. 

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… Read more »
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… Read more »
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… Read more »
Jonathan Berman

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……. 

Eric
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… Read more »
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… Read more »
Arthur
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,… Read more »
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