The glycated hemoglobin A1c (hbA1c) or A1c as it is known in the diabetes community, is a measure of how much glucose has “stuck” to the red blood cells over the course of 2-3 months. Hemoglobin is a protein found in your red blood cells. It gives our blood its red colour and carries oxygen throughout the body. When glucose (the sugar in our blood) builds up in our blood, it binds to the hemoglobin in the red blood cells. An A1c test measures how much sugar has bound to the red blood cells in the past 2-3 months.
Your A1c is not good or bad. It is a compass reading
When attending your regular diabetes checkup, waiting for the results of your A1c can feel like waiting in the principal’s office for your report card. Were you a good pancreas or a bad one over the past 2-3 months? Will your team praise you or scold you? These are often the thoughts that run through patients’ minds as they head into this visit.
The reality is that this isn’t a report card. It is more like a compass reading. It provides you with a direction from which to go forward.
Many things have gone into impacting your blood glucose levels. You may have been sick, stressed, or have started a new exercise routine. The highs and lows of life will result in the ups and downs in your results.
Work with your diabetes team
If you feel that your A1c is too high, take a bit of time to go over things with your team. Together you can discuss what may have impacted your results. You can also discuss what can you do in the future to bring your A1c more in line with goals set by you and your team.
They may also suggest studying your Time in Range to get a more accurate gauge of what is going on with your blood sugar levels.
What worked to keep my son’s A1c in a good range.
As a parent of a child with diabetes, I worked hard to keep my son’s blood glucose levels in a range that kept him as close to 7% or under as possible. That was easier to do when he was smaller. At that time, I had much more control of his food intake. I was able to closely monitor his activity level. He also did not have as many hormones to deal with as he did when he entered puberty.
We did manage to maintain quite respectable control well into his late teens. I attribute our success to a few things.
- Frequent blood glucose checking. I am a firm believer in data. Without the readings, it is impossible to make adjustments and keep on top of highs and lows. When my son was small, it was easy for me to grab a finger and check to see what his blood sugar was like at any given time. As a teen, we had vastly different ideas on what equated to an ideal amount of checks but still managed to make do with the information that we had.
- Using the data to make adjustments. Whether we had a teen amount of data or a larger pool from Mom checks, we carefully watched for trends. For the first few years, this was done with the supervision of our diabetes team. As time went by, they trusted us to make many of our own decisions and only looked at readings during clinic appointments.
If I saw a low blood glucose happening two or three times in a row and I did not have a good reason for it happening (he had been exercising or we had made a mistake in carb counting), I would adjust his insulin accordingly. When he was high, I would wait a little longer before making a change. I would want to see 3 or 4 readings that were off to make sure that it wasn’t a carb counting error or a site that was bad. It was important that there be a true pattern before changes were made.
- Logging food and activity levels. It was easier to find a pattern if I also monitored what he ate and what he was doing. Again, this was much easier to do with a toddler than it was a teenager. Together, however, we would try to gage what he ate and what he was doing to know if a change was warranted.
Other tips to help improve your A1c
Those were a few of the things that have worked for us, but here are a few other tricks from Diabetes Strong and the diabetes community.
- Prebolus. If you know that you will be eating within 20 minutes and you know the carb count in what you will be eating, bolus (inject) your fast-acting insulin ahead of your meal. This gives it time to be working in your system as the same time as your food. Doing this can help avoid some glucose spiking.
For small children or picky eaters, this can be challenging. One option is to bolus for half of what you think that they may eat beforehand and then give the rest of the insulin for the meal after you know what was consumed.
- Site rotation. Remember to always rotate your injection and infusion set sites. If scar tissue builds up, it will hinder insulin absorption and result in higher blood glucose levels.
- Work with your clinic. Once again, we can’t stress enough, always work with your clinic. This includes your doctor, nurse, and dietitian. They are the experts in diabetes care and you are the expert on your body. If you work together, you can come up with strategies that will keep you healthy and living your best life with diabetes.
When you meet with your diabetes team, you can feel overwhelmed by all of the information that you receive. Plan your appointment ahead of time by bringing notes with your own questions and take the time to do a quick recap after your appointment so you don’t forget anything.
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