Hey Betics,
During BootCamp for Betics this week, one of my students asked a really great question about what your A1C should be.
Question:
If my goal is to lower my A1C, how do I realistically determine what it could/should be in 3 months or 6 months? How do I figure that out?
Answer:
That's hard to answer since everyone is so different, but I'll give it a try. As you know, the A1C is a nicely predictive value that tells you and your doctor how well "controlled" your blood sugar is, but it is not a totally accurate data point.
For example, your blood sugar could be 40mg/dL 50% of the time and 240mg/dL the other 50% of the time and your A1C would be 6.5 (control is not great, but A1C is good). Likewise, your blood sugar could be 110mg/dL 50% of the time and 170 the other 50% of the time, and your A1C would still be 6.5 (control is much better, but the same A1C as before).
So while the A1C number is a good reference point, it's only part of the goal. Here's what I'd suggest.
First, choose a baseline target bg (wait, what the heck is a baseline target bg?) that is safe. Let's say, for example, you want your baseline bg to be 110 to start off, just to be on the safe side and avoid hypos (if you're not on insulin or sulfonylureas, your eventual baseline target should be lower than 110). Next, pick a max postprandial bg goal (post-eating for a type 1 can be 140-180, sometimes higher depending on your circumstances. If your A1C is currently above 7, start with 180, which I'll use in this example). Add the two numbers together (baseline goal + postprandial target = 110 + 180 = 290, and divide that total by 2. The answer in this case is 145, and that's your average blood sugar goal. Then, go to this website: http://www.phlaunt.com/diabetes/A1Ccalc.php and type your average blood sugar target into the mg/dL field, which will help you figure out what A1C that corresponds to (it's 6.7).
One thing you (and everyone else) should consider before lowering your A1C, though, is whether or not you have *any* diabetic retinopathy. If you have existing retinopathy (proliferative or not), you can exacerbate your eye issues by lowering your A1C too fast. If you don't have any preexisting retinopathy, this warning doesn't apply to you. But, the faster you can lower your A1C, the more your kidneys, heart and nerves will thank you. It's a total catch 22 if you have any retinopathy at all.
During BootCamp for Betics this week, one of my students asked a really great question about what your A1C should be.
Question:
If my goal is to lower my A1C, how do I realistically determine what it could/should be in 3 months or 6 months? How do I figure that out?
Answer:
That's hard to answer since everyone is so different, but I'll give it a try. As you know, the A1C is a nicely predictive value that tells you and your doctor how well "controlled" your blood sugar is, but it is not a totally accurate data point.
For example, your blood sugar could be 40mg/dL 50% of the time and 240mg/dL the other 50% of the time and your A1C would be 6.5 (control is not great, but A1C is good). Likewise, your blood sugar could be 110mg/dL 50% of the time and 170 the other 50% of the time, and your A1C would still be 6.5 (control is much better, but the same A1C as before).
So while the A1C number is a good reference point, it's only part of the goal. Here's what I'd suggest.
First, choose a baseline target bg (wait, what the heck is a baseline target bg?) that is safe. Let's say, for example, you want your baseline bg to be 110 to start off, just to be on the safe side and avoid hypos (if you're not on insulin or sulfonylureas, your eventual baseline target should be lower than 110). Next, pick a max postprandial bg goal (post-eating for a type 1 can be 140-180, sometimes higher depending on your circumstances. If your A1C is currently above 7, start with 180, which I'll use in this example). Add the two numbers together (baseline goal + postprandial target = 110 + 180 = 290, and divide that total by 2. The answer in this case is 145, and that's your average blood sugar goal. Then, go to this website: http://www.phlaunt.com/diabetes/A1Ccalc.php and type your average blood sugar target into the mg/dL field, which will help you figure out what A1C that corresponds to (it's 6.7).
One thing you (and everyone else) should consider before lowering your A1C, though, is whether or not you have *any* diabetic retinopathy. If you have existing retinopathy (proliferative or not), you can exacerbate your eye issues by lowering your A1C too fast. If you don't have any preexisting retinopathy, this warning doesn't apply to you. But, the faster you can lower your A1C, the more your kidneys, heart and nerves will thank you. It's a total catch 22 if you have any retinopathy at all.
So, if you do have retinopathy, then you need to take your current A1C into account and be careful to lower your A1C slowly. I think a half a percentage every month is slow enough, but you should check with your ophthalmologist about what they recommend. So, let's say your A1C is 9. Try to lower it to 8.5 by next month, then to 8 the month after that, etc., until you can get it to a healthful and attainable target. An A1C of 8.5 corresponds to an average blood sugar of 197 according to the A1C calculator. Multiply this average blood sugar by 2 (197x2 = 394), and then subtract your baseline target bg, which should be on the high side if you're looking to lower your A1C slowly. Let's say it's 130. So 394-130 is 264. 264 becomes your absolute "not to exceed" number for the month that you're trying to get your A1C to 8.5.
As for a *final* A1C goal, well, that's up to you. If you're prone to hypos, an A1C of 6 or even 6.5 may not be realistic for you, and you may want to hover right around 7, which isn't perfect, but again, it's another catch 22. You want to keep your bg low enough to not cause any complications, but you can't keep it so low that you have constant hypos and seizures.
With Betic Love,
Kara
As for a *final* A1C goal, well, that's up to you. If you're prone to hypos, an A1C of 6 or even 6.5 may not be realistic for you, and you may want to hover right around 7, which isn't perfect, but again, it's another catch 22. You want to keep your bg low enough to not cause any complications, but you can't keep it so low that you have constant hypos and seizures.
With Betic Love,
Kara
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