What if your A1c could do more than give an intermittent “diabetes report?”
And what if you and your diabetes plan would benefit greatly from knowing what the “more” is?
Before we get into the details, I need to add a disclaimer! While an A1c is heavily relied upon for making decisions about how well your diabetes plan is working, there are times it can be inaccurate.
For example, if you are African American, glucose may attach to your hemoglobin (a special part of your red blood cells) at a higher rate, meaning your A1c can show up slightly higher than someone of a different race.
Also, genetic or health conditions which effect your red blood cells, like sickle cell disease, chronic kidney disease, anemia, even pregnancy, often make your A1c results unreliable. This is also true if you’ve had significant blood loss or received blood transfusions.
There are other tests, like frutosamine, which can be used to give you and your PCP the “big picture” view of your diabetes plan. Checking your blood sugars regularly, or using a continuous glucose monitor can also help. Your health care team can help guide you on these options if there’s concern for A1c inaccuracy.
Assuming you and your PCP are confident your A1c is right on, here are 5 ways you can start turning your A1c into action….
1. Know Which Glucose Levels are Impacting Your A1c
Typically, the higher your A1c, the more your fasting blood sugar has impacted it. The closer your A1c is to your goal, the more your post meal levels affected it.
Knowing this can help guide your treatment plan. For example: if you’re slightly above your A1c goal, you may add in a walk after your biggest meal of the day. Or you may change your meal plan or trial a new medication, or insulin to carb ratio, that targets after meal blood sugar levels.
2. Track Your A1c as a Trend Rather than an Individual Event
Let’s say your recent A1c was 7.5%. Depending on where your previous levels were, this is either great news, or not so great news.
If your last two A1c levels were between 8-9%, then HOORAY, this A1c is trending, or moving, in a healthier direction!
But if your last two A1c levels were around 6-6.5%, then taking a closer look at your diabetes treatment plan may be a good idea.
In a nutshell, your A1c level is nothing without a gauge of where you’re coming from and goal of what you want for blood sugars. Looking at a single A1c does not give you enough information about your diabetes plan.
3. Use Your A1c to Create Conversations with Your Primary Care Provider (PCP)
When you know your A1c level, you can ask your PCP follow-up questions like:
“What is my A1c compared to my blood sugar levels?”
“Has that changed since last visit?”
“What should my A1c goal be?”
“What A1c level would warrant a change in my diabetes plan?”
“If my A1c hits the level where we need to make changes, what are those next steps?”
It sounds like the simplest thing, but just knowing your level can increase your awareness. Usually folks who know their A1c tend to have healthier blood sugars. Partially because they can push for a change in their diabetes plan if their A1c reaches unhealthy levels.
4. Use Your A1c to Set Personalized Goals with your PCP.
An A1c should vary based on your age, other health conditions, length of time you’ve had diabetes, and a host of other factors. Ask your PCP to make a comprehensive assessment of these factors and create a personalized A1c goal for you.
Looking for easy ways to ask? Here are some suggestions:
“Now that I’m diagnosed with heart disease, how does that change my A1c goals?”
“I’ve had diabetes over 20 years. At what point do we take a closer look at what my A1c goal should be?”
“I’m turning 70 years old this year, is there a certain age we need to look at changing my A1c goals?”
Having discussions like these can help protect you from unrealistic or even risky A1c goals.
5. Remember Lower is Not Always Better.
Because your A1c is a three month average of your blood sugars, a lower A1c can also signal you’re having a large number of low blood sugars.
Put on your “low blood sugar radar,” and do some investigating if you have an A1c under 6.5% and also:
- use medications that can cause low blood sugars (especially more than one kind)
- struggle to check blood sugars on a regular basis
- have diabetes complications or have had diabetes for many years
- have other health conditions (like heart or kidney disease) which increase your risk for lows or mask signs and symptoms of lows (due to medications you may need for those health conditions)
Checking blood sugars at home at various times to make sure you’re not having lows is a great start to figuring out the next steps in your diabetes plan. Having two or more lows in a week, time to rethink your diabetes plan.
Not having low blood sugars? Great, keep doing what you’re doing.
Summing it all up…. maximizing what you know about your A1c can help you make changes in your day to day diabetes plan AND advocate for yourself during your diabetes check-ups.
Megan Muñoz is the host of Type2andYou with Meg, the only podcast by a Certified Diabetes Care and Education Specialist dedicated to people living with type 2 diabetes. She holds a bachelor’s and master’s degree in nursing, along with certifications in medical surgical nursing and diabetes education. Megan works with a wide range of people living with type 1, type 2, and gestational diabetes in both the hospital and clinic setting. You can find her on Instagram @Type2andYou_by_a_cde, Facebook @Type2andYou with Meg or on her site, Type2andYou.org.