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A1C 6.4 ?

Question:
Just got results from my first 3-month lab work. The doctors office called and said my A1C is 6.4 and they don't need to see me, just do it all again in 3 months, they say. I'm happy to hear that I have a good A1C number, but it sure contradicts the numbers I get when I check 2x a day with the Accu-Chek. The numbers from that are all over the place:
Before Before
Breakfast Dinner
126 115
171
150 122
140 124
172 119
129 131
150 134
169 160
153 163
140 169
135 155
138 113
178 112
169 179
165 170
Like in another post where we discussed what difference it really makes to check often (or at all), based on my A1C result, I really think it doesn't. As long as I am careful to eat healthy, which to me means low carb, and exercise, I guess I'll be OK.
Although, in one post I read, said that if our BS stays up consistently for a long period of time, that is when the damage is done. I see mine has never been in the ADA or Endo recommended range, yet I'm told I'm OK with the A1C of 6.4. Go figure...
Answers:
jemindus -

Congratulations on an excellent A1c!

Roughly, that is the equivalent of 149 mg/dl blood sugar reading.

To me, my A1c reports tell me my true 3-month blood sugar averages because, being on exercise (maybe I should say diet and exercise) control, I don't get hypos. (The reason I don't consider diet as part of my diabetes control is that I overeat most of the time. But I always make sure that all my foods are heart-healthy.)

An A1c at or below 6.5% (7% per ADA), means that a type 2 is in good control of his diabetes.

Keep up the excellent work. Don't be surprised if your next one is better than 6.4%.

Based on my personal experience with t2d, one does not necessarily have to consciously work harder or eat less than he does now. Ones body will automatically do its part to prolong its life and to stay healthy provided that adequate foods nutrients are supplied and the required physical activities as well as healthy habits and practices are continuously done. In short, one should avoid by all means all old unhealthy habits and practices.

Bonny C Damocles
Answers:
Hi jemindus,
Your home test only tells you what your BS level is at that particular moment. You don't know what your BS level was several minutes before that or even a few minutes after. You also don't know what your level is while you are sleeping. BS levels bounce around throughout the day and night. Your A1C info helps you learn what your average level has been for the past few months. If you feel well and your A1C is good, you are doing fine. If your A1C is good, but you don't feel well, the A1C value could be misrepresenting your actual control. Because it is an average, lots of highs plus lots of lows average out to a perfect A1C.
Janis Roszler, RD, CDE, LD/N
Answers:
So don't be too discouraged if our numbers do jump around a little as long as our A1c is good? Mine is at 7 last time I checked however that was when I was NOT taking care of myself at all. Sometimes when testing I feel like I get obsessed with it which often becomes discouraging. i know that sounds funny! I have been working so hard at being healthy and getting on the right schedule that when i test and my numbers are not PERFECT I get upset or discouraged !!The A1c is more accurate then your meter right???
Answers:
Yes and No!! Daily testing lets you know what various foods do to your BS and you can make adjustments to keep BS in normal range after meals.

The A1C is an average over 3 months and does not show when BS drops low are is too high. The lows will average out the highs. This means you really will not know what is happening on a daily basis.The A1C shows an overall control level and daily testing will show how well you have your food and exercise under control.

The A1C and daily testing are both very important in keeping good control.

Misty
Answers:

gggtsg -

If you are talking to me, my answer is that the A1c is a good indicator of ones sugar control if the diabetic is on diet-and-exercise control.

From my experience, I have never had any hypo episodes so all my A1c results tell me how well I have been handling my diabetes for the last 3 months.

If a type 2 is on diabetes drugs and/or insulin, the chances of having hypos are present. Low readings will definitely skew the accuracy of A1c results.

Bonny C Damocles
Answers:
Jan,

The ADA and endo organization recommend 7.0 and 6.5 for the A1C respectively. Thus, you are in the recommend range, although you morning numbers are out of the range of tight control drived from studies of type-1s.

You are getting to the point of being close to needing additional treatment. If you can increase your exercise, reduce your food intake, and lose weight, you should be able to stay off medication for a long time. More over the exercise will help reduce the odds of complications that your diabetes has raised.

Type-2 diabetes is a disease that is easier to control the soon you start. Exercise and weight loss get much harder as one ages.

Good luck.

Chuck
Answers:


Back to the question of testing. So Since daily BG levels are all over the place, wheter you are testing or not, and varies substantially due to many factors, what good does it do to know the BG level, twice, three times or four times a day? I am DT2 not taking Insulin hence not in danger of Hypo, keep healthy diet and exercise (almost) daily. May I speculate that there is a little hype regarding daily testing? Sure it is a medical necassity for some but is it a medical must for everyone?
Answers:
Hi jeff,
Testing is worthless if you don't know how to use the results. Fasting and pre-meal results help you and your physician evaluate the effectiveness of the medication that you take and the physical activity that you do. They can also tell you if you need to add medication to your health regimen. If you don't currently take any medication, there is no need to run tests at this time each and every day, but you should test occasionally to spot any potential problems.

2-hour post meal tests help you evaluate how your food choices affect your blood sugar level. If you take insulin, these tests are essential. If you control your diabetes with diet and exercise alone, they can be done several times throughout the week to help you stay on track.

Blood glucose testing is not overrated, but should be used in a way that benefit you personally.
Janis Roszler, RD, CDE,LDN
Answers:
Jeff,

As you know I generally agree with your view of not needing to test much if on diet and exsrcise. Medically there isn't a good reason to test, except occasionally to see if control is being maintained.

There are some good non-medical reasons to test.

Motivation is a good reason, pre-meal testing is a good way to deter snaking between meals.

Like prescribed medication, what you eat, how and how long do you exercise, illness and your stress situation affect BG levels and the affect is different for each person. Testing to learn how foods affect your BGs, what exercise works best (both immediately after exercise and for several days), and checking BG under different stress situations will give you ideas about how to live with your diabetes more effectively. Testing when you are ill can lead to identifying high BGs needing medical attention. My belief is that if you don't have and know the purpose of testing then testing is of little value.

Chuck
Diabetes Mellitus Type
Diabetes Nursing

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