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Monday, October 25, 2010

A1c = 6.3 = Happy Me!

This morning I had my first endocrinologist appointment since having my Dexcom CGM.  I was very interested to see what this A1c would be and how close it matched to my average on Constance, which was 141 mg/dL.  According to this site which I just Googled, that should have corresponded to an A1c around 6.1.  And being the ever-studious patient, I actually printed out some graphs and tables from my Dexcom software.  This is a huge step for me because 1) I'm horrible at keeping logs and 2) even more horrible at bringing them to my appointments.  But this software is so easy to use and speaks to the nerd in me, so I brought the graphs that I thought were most useful and had the most information for my endo: 

This is by far my favorite graph from the software.  It shows the average (among other things) blood glucose levels for each hour of the day.  A God-send for adjusting basal rates.  

This histogram plot shows where I spend most of my time on the blood glucose scale.  Most of the time I'm in the 101-160 mg/dL range. 
Armed with these fancy charts and graphs, I headed to my endo's office for my 8:30 AM appointment . . . all the way across town . . . in rush hour traffic.  I was so afraid I was going to be late that I could sense my stress levels going up.  Even with a stop for coffee (mmmm!), I made it with 3 minutes to spare before my appointment time.  I took my seat and prepared for the long wait (P.S. this is why I stopped for coffee).  I was enjoying watching an episode of "Are you Smarter than a 5th Grader?" on the lobby TV because it was the Pet Lover's episode and the contestant had a rescued border collie.  Thirty minutes passed and my name was called.

I make my way into the hallway and the nurse motioned me to step on the scale.  I always giggle when I get weighed there because there's a little comic strip above the scale that says, "Don't step on it.  It will make you cry!"  So true, so true.  Then I take a seat in my room while my nurse takes my blood sugar, A1c, blood pressure, and pump readings.  We chatted a little while waiting on my A1c (it takes 10 minutes to do its thing).  I heard the machine stop, but I was at a weird angle to see it.  And I didn't want to be all "What is it?!  What is it?!", so I waited for the nurse to tell me.  She looks back at the machine, "6.3, good job."  "Thanks,"  I said while doing a congratulatory dance in my head.  She left and told me that the doctor would be in shortly.

Enough time passed for me to snap a pic of the little room where I got my A1c:

Note the 3D model of a thyroid at 10 o'clock. 
Then he came in (I really should find a clever nickname for him other than "my endo" /digression), and said, "Your A1c looks great."  "Thanks."  He does some clickity click on the computer, checks my eyes, and asks me if I need any prescriptions filled.  "Just insulin."  After the confusion mess last time trying to get my strips refilled, I was glad I still have 6 months on those.  Then came the most awkward question from my endo that I've ever received:

"You're trying to get pregnant, right?"

I'm not sure if my eyes got as big as I felt they did, but I was able to rebut that statement pretty quickly, "Now right now.  We're just in the planning stages."  You see, in the process of trying to get insurance coverage for my CGM, I kind of had to play the "I wanna have kids someday" card.  And nothing screams "INSURANCE APPROVED" more than a procreating type 1 diabetic woman, right?

It's true that Trey and I do want to have kids some day, and a house full of them.  But the time is not quite right for us . . . yet.  And I don't say that like we don't have a plan and I'm waving my hand, "Oh, someday."  No, we have a PLAN, but it's just not right now.  And I'm not at a comfortable enough disclosure level with you guys to let those plans be known.  (But I still love ya!)  Then my endo turned to me and said, "Well, you have good control now that you'd be OK."  I'm glad that diabetes won't be something we have to wait on. /end awkward moment

He filled my prescription for my Novolog, and I went on my merry way.  But something that I did notice was that my endo was sort of shuffling me out of his office.  He seemed happy with my A1c, but it was almost as if the good A1c didn't merit any questions from me.  Not like when I came to his office crying last February where he let me ask "Am I going to die?" over and over.  It's slightly less dramatic than that, but I did wonder about my blood results, and my thyroid,and my finger stick test, and my blood pressure.  It seems that there's only discussion if your results are a little abnormal, otherwise, no news is good news.

There is something a little unsettling about that.  For example, I didn't even know what "good" blood pressure was until I had a bad one after a stressful day.  And I didn't know what a "good" cholesterol level was until it was pointed out that mine was a little elevated.  Just because I seem to be on the right track doesn't mean I don't want to know where the wrong track is.  I suppose that's part of being an involved patient, I want to know all the gory details of my body, even the good stuff.

So, to end this post (can you tell I'm trying to draw a conclusion?), A1c is good and lower than my 6.5 last time.  I've once again realized that my endo is a very small part of my diabetes management, and that most of the responsibility (and victory) goes to me.  I should go buy myself a trophy, or at least a diet soda . . .


  1. Oh, I love this post. For several reasons.

    1. Dexcom graphs = LOVE. I print the ones you do, plus the "summary" page, and one other I can't remember the name of at the moment. My only gripe, as I mentioned on Twitter, is that I'd like an "omit" button for certain periods of time. I feel like the Dexcom's inaccuracy in the first and last days of sensor use skews the results my doctor and I are looking at.

    2. I am with you on the "love you guys, but..." disclosure point. So much I want to talk about, but I have to reel myself in and remember "Once it's out there, I can't take it back."

    3. WAY TO GO HOLLY! That's an awesome A1C and I know you had to work very hard to get there, and will continue to do so. I wonder which one of us can get to the Mecca (6.0) first? :)

  2. Ahhh, the "baby-ready" 6.0 A1c. That's one of those elements in my "PLAN" that's undisclosed (well I guess not now, huh?). Even thought my endo is happy with 6.3, my personal goal for myself has ALWAYS been 6.0. I achieved it with my first A1c with Arnold and haven't seen it since, lol. I'm hoping my downward trend will get me there by the time we're ready for . . . ahem . . . action. =P

  3. YAY HOLLY!!! What a great A1c, you should be super proud. I sure am super proud to call you my D-sista!!!!

  4. Those Dexcom graphs are things of beauty. Makes my MM ones look like stick figures.

    Congratulations to you!

  5. YAY for the awesome A1C!! And, your endo and mine must have been on the same wave length, I did get a chance to ask questions and I wanted her advice on whether to tweak a basal or an I:C ratio or some combo of the two and she responded with "You know what to do." I think they do mentally triage us by our numbers. Maybe there's an insurance company "sliding scale" where your minutes with the doc are determined by your A1C??

  6. Hi,

    I'm typically a lurker, but I felt I had to comment on the link to the page you found on Google for blood glucose/HbA1c conversion. I think that link should come with a disclaimer. I read through the whole page, and I don't think you should be directing people there. While the chart seems to be helpful, the remainder of the information provided there strikes me as dangerous and not at all helpful to newly diagnosed diabetics (specifically) looking for information.

    I just wanted to make sure you were aware of what the rest of the page preaches, and hope you might reconsider linking there.

  7. @SBurgwin: Point taken. I definitely don't advocate any certain website (except for the awesome blogs down there on the right), but I was simply referencing the table. This blog is by no means a right way to reference any material for your (or whoever's) diabetes management. Everyone is responsible for their own care. I realize that some people are Googling for other people's perspective on how to manage their diabetes, but we're all simply that--other people. I hope no one looks to me (or any links) as a certified reference for any part of their diabetes regimen (see also: my DISCLAIMER at the bottom of the page). This is a personal blog, filled with plenty of flaws.

    But thanks for the heads up. =)

  8. Congrats on the AWESOME A1C!!!!! I can't wait for January to get here to see what my daughters A1C will be after 4 months on the pump. She's been pumping for 4 days now and her numbers have already improved GREATLY!!

  9. Way to go!! As defeated as we can sometimes feel with diabetes, days like this remind us that it is all worth it- happy, healthy results! Woo Hoo! Celebrate!

  10. Congrats! I love, love, love DexCom reporting. Pretty. ;)


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DISCLAIMER: I am not a doctor, nurse, certified diabetes educator (CDE) or any medical professional of any kind. (But I did stay at a Holiday Inn Express!) Therefore, please do not use any of my postings as medical fact. I am simply a blogger expressing my highs and lows (pun intended) with diabetes. For changes in your medication, exercise regiment, or diet please consult a qualified physician.

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My name is Holly and I live in north Alabama with my hubby, two cats, and a dog.