This is my blog…nacho blog

A1c Proud

Last week, I met with my Certified Diabetes Educator (CDE). I see her biannually and always look forward to our appointments. She is not only a CDE but a nutritionist as well. She also plays the role of therapist & friend very well in addition to her clinical duties.

She emailed me a week before our appointment to reschedule for 40 minutes later at which point I requested she get orders for an A1c test. I haven’t seen my endo since February and due to a scheduling snafu on my end, won’t see him again until October. Because I came off my pump six months ago & have been on Multiple Daily Injections (MDI) since, I wanted that snapshot of “how I’m doing.”

During my appointment we discussed the graphs I brought in from information I got from my Dexcom, my glucometer and the app I use to track insulin. We also discussed how I can get back into the gym. Not having a pump in which to control my basal rates has been giving me a fair amount of anxiety when it comes to exercise. But I’m also currently dealing with some body image issues and I know getting back in the gym will alleviate those somewhat. We made a plan and I’m actually quite excited to get my body moving again!

We also took time to discuss where I am at mentally & emotionally. She’s aware of what’s going on in my personal life and she genuinely likes to make sure I am well on all levels. Maybe this is because I’ve been seeing her since my diagnosis ten years ago and that initial diagnosis was concurrent with the end of my first marriage (Diagnosis, 4/27. Official separation, 4/29). I was so broken then. So fundamentally broken at my very core. Diabetes & mental health being intertwined was a lesson I learned the hard way very early on.

Then, at the end of my appointment, we discussed my A1c results. Last check was a 6.4. It induced happy tears right in the office as it was my first snapshot off my pump. I let her know both Ryan & I had guessed it would be 6.7 this time but I also let her know I was prepared for a 7.0. Well, we were both wrong. It was STILL a 6.4! Cue more happy tears and high praise from my doctor. But she still focused more on the straight lines on my overnight graph and how well I was managing my disease in the face of some current adversities. She has always made me feel like I am MORE than what my numbers say.  I am grateful that I have a clinician that values the whole picture. She would’ve praised my management even if my A1c came in above goal. She doesn’t chastise and she doesn’t shame. She validates and guides me in this journey. I know so many of my fellow PWD aren’t so lucky.

In the days following my appointment, I have seen some in the Diabetes Online Community (DOC) discussing A1c. The discussion has mostly revolved around how it’s not a valid or accurate measure of someone’s management. For some reason (um, because I’m me!), I have taken this personally even though I KNOW this was never the intent.

The A1c target for a Type 1 Diabetic is a 7.0 per the ADA. My lowest ever (3 months after diagnosis – I blame/credit The Divorce Diet) was a 5.9. My highest was a 9.4. Due to simply being the person I am, I choose to use my A1c and my appointments with my endocrinologist/CDE as both motivation and validation. I know others don’t view it this way, and that’s totally their business and I respect it.

With all that said, I have accepted that numbers run MY life. Not just the amount of glucose in my blood and physically how that makes me feel, but mentally & emotionally as well. I have decided to embrace my A1c what information I CAN glean from it. That means when it’s 6.4, 7.0 or 10.0. What it does NOT mean is that I judge ANYONE else for THEIR A1c. It goes back to my favorite core ideology of the DOC, Your Diabetes May Vary (YMDV). What works for me, isn’t going to work for someone else and vice versa. For crying out loud,  what worked for me today probably won’t work for me again tomorrow!  I love the DOC because that feeling of someone who TRULY “gets it” is so invaluable in my management. But I try to remain aware that everyone’s experiences are different.

I crave a way to be validated, always. And usually via external sources since I’m not very nice to myself a lot of the time (at least I know it?). After this last result, both Ryan and my CDE chided me for not giving myself enough credit. The last two A1c results cemented to me that all the work I have put in to switch from my pump to MDI was working. Just like that A1c years ago of a 9.4 was a reminder that maybe I had to take a look at my management and figure out why the hard work WASN’T getting the results I wanted.

Basically, everyone decides for themselves how they view their own A1c results and we all have doctors with different opinions on the topic as well. For me, I don’t let my A1c define me but it is a tool I use to fine tune my management. And it’s something I celebrate when I feel it worthy. Usually with ice cream. And if it doesn’t feel worthy of celebrating, ice cream usually helps then too. xoxo





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