Worst A1c Since Diagnosis, But It’s Coming Down


After putting it off for as long as possible, I got my quarterly blood work done last Wednesday. I expected disappointing results and wasn’t very surprised with them when they came in. In a way, I was a little relieved.

After months of high blood sugar and days of chasing down my numbers with correction after correction, I was sure my A1c was going to be terrible.

It took a few days for the result to come in and while I waited, checking online every few hours, my fructosamine result came in.

I wouldn’t have noticed fructosamine at all, but for the fact that it was totally out of range – 571 (normal range is 122-236).  I had no clue what that meant. So I looked it up and according to Wikipedia and a bunch of other sources it measures average blood sugar levels over three weeks and is used when an A1c test is not useful (like when an extreme change in diet has taken place over the last few weeks). It is also uncertain exactly how this translates to A1c or blood sugar levels since it changes from lab to lab (again, according to Wikipedia) but the bottom line was that my 571 result translated into a little over 11% A1c. 

My original fear had been an A1c of over 8%, but 11% seemed impossible.  So before totally freaking out I decided to wait for my A1c to come in.  Although it was the highest it has been since my type 1 diabetes diagnosis 11 years ago, I’m happy to say that it was only 7.4%.

This is very far from being good news especially since I was hoping to improve my A1c, but there is an upside to it all.  I think I’ve finally figured something out – my basal rate was too low.  

On Wednesday, after waking up with a BG of 240, I decided to set a temporary basal rate of 120% and since then my blood sugar has been significantly lower. I may need to tweak it a bit but the direction is definitely correct. The only real problem is my endo, who wants my basal to bolus ratio to be lower. She claims only people with type 2 diabetes have a 60%-70% basal to 30%-40% bolus ratio. I’ve tried to explain that I eat low carb but it seems not to register.  I feel like with all her very good intensions she doesn’t understand that I know more about my diabetes than she does. I live with it 24/7 and she sees me for 15 minutes every 3-4 months.

So I’ll have to wait and see what she actually says but if I need to ignore her recommendation I will because it’s my A1c and it’s coming down.

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Kari Winder
9 years ago

Interesting, what your endo said about basal/bolus ratios.  I have a pretty consistently 60% basal/40% bolus ratio and I DON’T even eat that low-carb most of the time, and I’m not Type 2. I just require quite a lot of basal insulin. I think your endo needs to wake up and realize that no two people with diabetes are the same, and what’s best for you is to ultimately find the basal rate that keeps you in range – even if it messes with the ratio she THINKS is best. Setting you up to use a particular ratio is a… Read more »

9 years ago

definitely experiment with change … yes, YOU are the expert in your diabetes.  It makes sense that the type of foods you are eating taking longer to break down into glucose and the basal would help would that.  Good luck!  And keep in mind, there are many T1’s who would love to have your A1C.  :-)

Jeff Nobles
Jeff N.
9 years ago

Thanks very much for sharing this, Michael.  It is close to some of my own experiences and validating for me to see your posting about your recent struggles–even though I am sorry you are having them.  I also appreciate your point about your endoc.  Same here. Unless you live with T1D 24/7 you cannot really understand many of the issues.  Best wishes to you.

9 years ago

Well done ! Go for it ! I eat very low carb and I have actually  REDUCED my basal –lantus– in HALF from 24U/24hr to 12U/24hr (6+6)  since years ago. It may require more tweaking from you not your endo. It can also help to SPLIT your basal in half (half every 12 hrs). I know everyone is different. THIS IS NOT MEDICAL ADVICE

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