Wednesday, May 16, 2012

When you have Diabetes, you get to spend a lot of time visiting your doctor. Every three months, I get to visit the office of my endocrinologist - a woman with a bedside manner so dry it is almost painful for the both of us - and have a blood draw to check my HbA1c (or A1c), which is a measure of my average blood glucose over the prior three months. A typical A1c for a person without diabetes is about 5%. The target is a bit higher for a person with diabetes...though the matter is up for a bit of debate. The American Diabetes Association recommends an A1c target of less than or equal to 7%. The American Association of Clinical Endocrinologists recommends a level of 6.5% or below. I'm pretty conservative when it comes to my diabetes management, so I aim for around 6%.

With all that in mind, I went in last week for yet another visit with Dr. Bland. On the appointed day, I made my way to the check-in desk, where a semi-medical professional conducted a thorough examination of my health insurance ID card, and made me sign a form stating that I have a right to privacy, and they have the right to abduct my first born in the dead of night should I fail to remit payment in a timely manner. I was then left to mill about the waiting room with three or four dozen other patients (several clearly deceased) and old Woman's Day magazines for a period ranging from one to four hours.
Luckily, I managed to find a stack of these to occupy some time.  >>> 

After a really long time (how long, I cannot say), dehydrated and sufficiently demoralized, I was placed in a stark examination room furnished with a plastic chair, a paper-covered examination table and a large, detailed color diagram of the human endocrine system. The semi-medical professional took my blood pressure and checked my pulse, no doubt to ensure I had not gone the way of the patrons in the waiting room. I was then left alone to stare at the diagram and thumb through old issues of TIME. The minutes tick by. Fifteen minutes. Thirty minutes. I begin to wonder if I have been forgotten...

At last, Dr. Bland appeared, obviously in a hurry to ensure other patients were not...uh...kept waiting? The good doctor moved at the speed of a ninja. I got a .016-second pleasantry before she started madly penning things in my chart. I can only imagine what might be contained in that manila folder, but no doubt it has nothing to do with my general awesomeness. Then, with the speed of a kamikaze pilot, she disappeared.

A phlebotomist came in to do the blood draw.  As I sat down in the chair and rolled up my sleeves, the person taking the blood politely inquired, “Which arm would you like me to use?”

Someone else's?

Truthfully, I have never had issues with needles. Even as a kid, I was pretty low-key about the whole business, and having been diabetic for five years now, I'm better still with sharp things and skin. The crappy parts of having diabetes have nothing to do with shots and needles, and everything to do with trying to manage numbers...the numbers we are about to check. It's not about getting stabbed a bazillion times. It's about making sure I can live long and well. Before every check of my A1c, I reflect on the morning I got up and found my blood sugar was sky-high, or all the times on airplanes when I was running over 300, or the time I forgot to correct for a cookie.

With the blood draw done, I checked out and set up another appointment in another 90 days. And then I wait...

Yesterday, my results came in the mail:

Tiny font, you say?

My HbA1c was 5.4%.

That, I might add, trumps my non-'betic better half, who had an HbA1c of 5.6% at his annual physical. In short, my blood sugar is the same as a person without diabetes.

I should point out here that this kind of number may or may not be ideal for all persons with Diabetes. Two studies published in the New England Journal of Medicine looked at the benefits and risk of intensive blood glucose control in persons with Type 2. The results of both studies suggest it may be more harmful than beneficial to target the A1c less than 6.5%, especially if the person with Type 2 has elevated cardiac risk factors (which many do) as attributable to excess weight, hypertension or hypercholesterol. These same studies did not examine persons with Type 1, and it is only intuitive to me that my risk factors for things like heart disease (CVD), peripheral neuropathy, amputations, retinopathy, and kidney disease would be the same as the non-diabetic population with a similar HbA1c.

Really, though, the point of all this is control. No one knows "the magic number," and no one can say when you cross the threshold of "safe."  What I can tell you is that I work really hard to keep my blood sugar as normal as possible. I test often. I eat well. I exercise every damn day, whether I feel like it or not. And the natural result, for me, is normal. I feel good. Plenty of Type 1's strive to lower their A1c, only to swing from high to low...correct...end up high again...send their blood sugar to the basement to try and keep that percentage under a certain predetermined goal... That's not control, either. Control is when you have managed down your risks insofar as practical, and you still feel healthy and fit and empowered and unafraid. It's the place where you are comfortable with your physical being, where you wake most days feeling pretty good, where you are best able to do the things you wish to do with minimal interference from diabetes. It's not about a's about balancing the demands of your life with the demands of staying healthy. I'm there, and it rocks.


  1. I will admit I am totally and completely in awe of your A1C. You, my friend, are a superstar. I think I'm one of those people that couldn't get my A1C that low even if I was perma-hypo.
    Way to go... seriously!

  2. The last time I had this kind of A1c, I was low all the time. It was misery. I think I have reached a point where I just know myself a bit better. I should add that I think a lot of the other athletes have been helpful. Honestly, it never dawned on me that I could have an average BG around 100 until I met a guy on the Tri team who manages down to 80. But thanks for the props! I was pleased!