Why check glucose if A1C OK?

[jlshand]

New to the group. Have a question I've been pondering awhile. The premise is that we all pretty much know(after awhile) what we eat that will spike our blood sugar. So........ if someone is using A1C, say every other month, and the numbers resulting are good, Why finger stick multiple times everyday ?????

Thanks for facts and opinions

[ProudNanaof5]

Welcome:wavey: I am a type 1 and even tho my A1c might be good I have to check bs atleast 8 times a day. I do this to adjust my insulin. Are you type 1 or type 2 or type 1.5?

[jlshand]

Sorry I overlooked mentioning I am type 2

[Cyborg]

Welcome aboard. :wavey:

That is a good question. If you had an excellent a1c and you didn't need any improvement, why would a type 2 need to test?

[liz32]

without testing you might not get such a good A1C. You might slowly slip and you numbers may creep up unaware.

Liz

[spike]

Welcome aboard. :wavey:

That is a good question. If you had an excellent a1c and you didn't need any improvement, why would a type 2 need to test?

That assumes they don't get hypo.

[thaivh]

hello everyone. Could someone tell me what A1c is? Is there a name for this? I do see a Glucose Random section from looking at my lab results.

thx

[Mich]

You need testing during the day to see the pattern of your hour-by-hour blood glucose and also to identify the things that give you a spike after eating them.

I have in the past, had perfect A1c's and my hour-to-hour numbers had been all over the map. (I am what they used to call a BRITTLE type 1)

Since A1c's are only an average, be sure you know how your body works with sugar/carbs by testing regularly. After a while, you will be able to not test so much as you learn your reactions to certain foods, stress, the stress of illness, etc.

Mich

[Cyborg]

hello everyone. Could someone tell me what A1c is? Is there a name for this? I do see a Glucose Random section from looking at my lab results.

thx

Your Hemoglobin A1c value is essentially a number from blood work that represents your average bg over the last 3 months, weighted towards the present...

[seacomp]

if someone is using A1C, say every other month, and the numbers resulting are good
The first issue is to define a "good A1C". The official organizations tend to regard under 7.0 as a good A1C; this is an average BG of 172 (9.6). Since you pass sugar in the urine at 180 and incur damage at over 140 (according to many reports), I would not consider this good.
For someone taking insulin, an A1c of 6 or under would be good. Without insulin, a normal A1C of 4.7 to 5.0 should be the goal. (Most insulin users can't reach that goal because of the dangers of "lows").
If a non-insulin using T2* has an A1C in the normal range, then there is little reason to test more than a few times a week to catch any "drift" upwards.
However, a "good" A1C of, say, 6.3 for the same person means that BG is not competely under control. If you desire to lower your risk of complications and heart problems to the minimum, then you want your BG as near normal as possible and it makes sense to test often to see what can be improved.

* It is common to equate T2s with non-insulin dependent. However, most takers of insulin are T2s, and most T2s eventually end up on insulin.

[Cyborg]

However, most takers of insulin are T2s, and most T2s eventually end up on insulin.

Hmmm.... Wonder what a poll of type 2's would indicate. I'm guessing most don't end up on insulin.

[seacomp]

Hmmm.... Wonder what a poll of type 2's would indicate. I'm guessing most don't end up on insulin.
I haven't directly seen the studies, rather I've noted what various doctors have written. One doctor indicated that 28% of T2s are on insulin, another 35%, yet another that all T2s will eventually require insulin if they live long enough (although many refuse injections nevertheless). My own feeling is that insulin is not ultimately required, but that halting the progression of the disease can be very difficult.

A poll of member of this forum would not be very representative. The median age of T2s is about 65 so many would not even have/use a computer. A poll of T2s on insulin use 15 years after DX however, might be useful.

[mg_2204]

if someone is using A1C, say every other month, and the numbers resulting are good, Why finger stick multiple times everyday ?????


(1) To make sure everything is ok on a day to day basis.

(2) Spot possible problems before A1C suffers from it. And health!

(3) To check how blood glucose reacts after certain foods.

(4) When sick or under high stress it's a must to check.

(5) Peace of mind.

(6) Keeps you focussed on keeping your levels within a normal range.

[Funnygrl]

My last a1c was 5.0%. Should I stop testing?

[lgvincent]

HbA1c gives you an idea of long-range blood sugar average while checking one's blood sugar will give you an immediate reading and blood sugar is in a constant state of change.

[Harold]

New to the group. Have a question I've been pondering awhile. The premise is that we all pretty much know(after awhile) what we eat that will spike our blood sugar. So........ if someone is using A1C, say every other month, and the numbers resulting are good, Why finger stick multiple times everyday ?????

Thanks for facts and opinions
Mostly Opinion from my and others experiences.
1) Most type 2's do not get A1c's done every other month. Most get them probably once or twice a year. Some managing their diabetes insist on having them done ever 3 or 4 months.

2) Type 2's not on insulin do not need to test multiple times a day everyday. Four times a day 3 days a week is plenty if your A1c is under 6.2 to 6.5.

3) Type 2 diabetes is a PROGRESSIVE desease. This progression seldom goes in a linear manner, it goes by leaps and bounds. Like type 1 it goes up and down with the seasons, phases of the moon, and mostly for no apparent reason. To say the least it is constantly changing. Which means how your body reacts to different foods changes over time. As you said above "The Premis..." is exactly that it is assuming how something affected you 6 months ago or even last month will have the same affect today. The idea is dangerous, it is what leads people into a false sense of security and it gets them into trouble. This fortunately does not mean your diet will become more restrictive. You may find that foods that affected you badly last year are not as bad this year. On the other hand some foods that you found fairly safe last year you may have to stop eating this year because they now affect you badly. Every aspect of this desease is constantly changing and the only way to stay on top of it is by testing often enough to detect changes in trends and act on them.

[TenderVittleS]

I test often because the key to control is prevention. If you know your BS is going down constantly you can prevent hypoglycemia and vice versa. Also I live alone so I have to be extra careful.

[jjordie]

Having had erratic BG readings over many months - I like to test often (4 x daily).
My latest A1c was 8.8 -
Doc says that's OK - you are keeping stable!

I do not like being at that level and am still working on reducing it.
Would anybody on here be happy to accept that number?

I am also finding that things I could eat some time ago are not so good for me now.

[Harold]

No, I would not be a happy camper at that level. My personel goal is to keep it below 6.2. Above 6.2 is where eye complications start happening.

[JediSkipdogg]

Having had erratic BG readings over many months - I like to test often (4 x daily).
My latest A1c was 8.8 -
Doc says that's OK - you are keeping stable!

I do not like being at that level and am still working on reducing it.
Would anybody on here be happy to accept that number?

I am also finding that things I could eat some time ago are not so good for me now.

I would not be happy at that level. Now....if say that was a 7.0 or even a 7.5, and your numbers were pretty darn steady, I'd be happy. One other complication many don't think about is that fluctuating BGs are actually just as dangerous, if not more, than high steady ones. Rapidly changing BGs greatly affect the vessels in the eye and can lead to eye complications such as blindness. But so can a steady high. The level for each of those is really unknown, but as close to a 5.0% A1C and levels 80-100 would be the goal to shoot for.

[Stuboy]

i guess the question is... when you do test, do you ever need to "take action" as a result from that test? If so... i'd say you get good A1c results because you take the appropriate action from a test result... without taking that test you wouldn't have taken any action and things may have turned out differently.

[DeusXM]

Having had erratic BG readings over many months - I like to test often (4 x daily).
My latest A1c was 8.8 -
Doc says that's OK - you are keeping stable!

I do not like being at that level and am still working on reducing it.
Would anybody on here be happy to accept that number?

Four times a day isn't really 'often' - to be honest that's the bare minimum I'd test a day and I'm nearer 8-10 tests.

Also be aware that both NHS, WHO and Diabetes UK guidelines say that you should be aiming for a maximum A1C of 7.0 - although this can also be dependent on the patient.

[Michele]

I'm 36yrs old, Type 2, I test 4-8 times a day. My doctor does my A1C every 3 months, not because I ask or insist that it's done, it's an important test that he uses in the way he treats my diabetes. We've been doing that for 5 years. I test because something that didn't affect my BS yesterday may very well today. I also test because I take a couple meds that make me go low and if I have a low I feel terrible the rest of the day, and I don't always feel it coming on till it's hit. I'm not on insulin, I treat with a few pills, and started Byetta in Aug 06. My A1C has never been over 8.2 (I do know that's high) , that was when I was first diagnosised in Sept 2001. I've usually kept my A1C around 5.0 or 6.0 since then, until recently I went up to 8.0 again, and again it's because the disease changes, I believe that's why it's so important to always test. I'll have my A1C done again Nov 1st and suspect that I'll be where I should be again just from the numbers I have gotten from frequent testing and making changes in my diet and changing meds. JMO.

[Cyborg]

No, I would not be a happy camper at that level. My personel goal is to keep it below 6.2. Above 6.2 is where eye complications start happening.

That's nice to know. I'd like to see mroe info on a1c values and the correlation to complications.

[Harold]

That's nice to know. I'd like to see more info on a1c values and the correlation to complications.
Sure why not, I would?
Link to the whole paper: American College of Endocrinology Consensus Statement
on Guidelines for Glycemic Control* (http://www.aace.com/meetings/consensus/dcc/pdf/dccwhitepaper.pdf)

For those not wanting to read the whole paper;
Hemoglobin A1c Target
In the epidemiologic analysis of the UKPDS data, the
risk for occurrence of microvascular and macrovascular
complications was shown to increase at HbA1c values of
6.5% or more (6). In the 6-year follow-up data of the
UKPDS, the two-step progression of retinopathy was
increased more than fourfold in the middle tertile of
patients with HbA1c values of 6.2 to 7.5% in comparison
with the tertile with HbA1c values <6.2%. HbA1c values
>7.5% were associated with little additional progression of
retinopathy beyond that seen for the range of 6.2 to 7.5%
(30). A few smaller cohort trials further corroborate the
significance of HbA1c elevations that exceed 6.5% (31-
33). These findings are also consistent with several epidemiologic
studies that have implicated the association of
high HbA1c levels with the development of complications
of diabetes, especially atherosclerosis (even in cohorts
without diabetes) (34). No differential effect of hyperglycemia
on rates of occurrence of microvascular complications
could be observed between the data obtained in
patients with type 1 and those with type 2 diabetes. The
data from the DCCT (35) showed a relationship between
HbA1c and the incidence of retinopathy, similar to that
seen in the UKPDS. Moreover, in both studies, glycemic
reductions yielded similar benefits with regard to the incidence
of retinopathy and nephropathy for equal degrees of
HbA1c reduction.

[jjordie]

Thanks all - you've cheered me up no end :(

I mostly test before meals and last thing at night.

Think I will be having another chat with my GP.

[Cyborg]

Harold, nice doc. Thanks. :beer:

[Harold]

Cyborg, You are Welcomed! More :beer:

[seacomp]

In relation to Harold's quote and other similar studies, figures like a 6.2% HbA1c are not "magic numbers". That is, magic in the sense of everything under that number is good and higher than it is bad. Rather it is a line drawn thru the data to make statistical comparisions with. In order to make the mathematical/statistical calculations that scientists need to present their papers, they need to group their data. In this case, the cutoff between the lowest third of results and the middle third was at an A1C of 6.2% so that's where the statistical test was made.
Every study actually tends to show that the neared the A1C is to normal, 4.7% to 5.0%, the better off you are and the lower chance there is for complications.
(However, this may not be true for heart problems and Type 2s with "metabolic syndrome". In this case, the risk of heart attack may not be as directly related to BG levels.)

[Fenway]

New to the group. Have a question I've been pondering awhile. The premise is that we all pretty much know(after awhile) what we eat that will spike our blood sugar. So........ if someone is using A1C, say every other month, and the numbers resulting are good, Why finger stick multiple times everyday ?????

Thanks for facts and opinions

You sound like my PCP, soon to be fired. If I didn't check my glucose on a daily basis, my A1c would soon rise, and I would need to go on medication. Right now I'm doing fine with diet and exercise and checking my glucose at least 3x per day.

[Harold]

They are all MAGIC numbers especially that 4.7% - 5%. :ridinghor

Just trying to stay away from that four-fold increase in my chances. Now if someone would point out where I could increase my chances with the lottery by four-fold I would be highly interested. :tee:

[Cyborg]

You stay alive to a ripe old age with this disease and you've won the lottery, IMO...

[seacomp]

They are all MAGIC numbers especially that 4.7% - 5%. :ridinghor
That's what you can expect for an A1C for a non-diabetic, or if there were a cure(s) for diabetes, so in that aspect it would be "magic".

[pam]

I check my blood sugar maybe every 4-6 weeks. I have my A1C done every 6 months at the doctor's office.

I know my body well enough that if my sugar goes up a little bit (150 or so) I know it .... my lips will get drier or the corners of my mouth turn a little bit red.