Thursday 7 July 2011

What's the HcA1c Secret?

I've been a type 1 diabetic now (insulin dependent) for almost 25 years now. In that time I have learnt how to carbohydrate count, how to calculate insulin doses, how to change a cannula and fill an insulin pump reservoir. I've learnt a whole diabetic language consisting of words like pre-prandial (before a meal), post-prandial (obvious, really), nephropathy (kidney damage) and retinopathy (eye damage). I've learnt that fruit isn't always good for you and that sometimes even with all the best efforts in the world, blood sugars will just seem to throw the most enormous hissy fit right about the time I have a 'colourful language' moment.

But all in all I consider myself a 'good' diabetic (as opposed to an evil one I suppose) and I spend an inordinate amount of time each day fixated on adjusting this, weighing that and calculating the other. But despite my best and most dedicated efforts, I have never in my living memory achieved an HbA1c of 7%. An HbA1c (so as not to get all technical) is a magic number that us diabetics have to aim towards and measures the amount of Haemoglobin being carried around the body by the red blood cells. Above 7 = bad. Below 7 = good. 6.5 = Mother Teresa.

Well that is a lot easier said than done seeing as normal life as a diabetic can involve more peaks and troughs than a day at Alton Towers and sometimes all before we get out of bed.

So what can equip us to do this? Well, 18 months ago I was given the first tool I could use; the insulin pump. Thanks to the unique ability of the pump to supply insulin tailored to my exact needs - as much as can be - it was the first component which gave me the opportunity to try and lower my A1c. At the time I was 9.6% and heading for complication city (that's actually a place you know, just north of Bullshitville and south west of Scaring People Shit-less), but thanks the the pump, after 6 months and with no changes other than the pump itself, this dropped to 8.2%.

Good job, pumpy!

The next step was the revelation of the low-carb diet and exercise combination which I discovered towards the end of last year, after reading several blogs, online resources and books all about how eating low carb (and I mean LOW!) and exercising regularly in a certain way had helped people to achieve near normal BG results. After a bit of experimenting, this chick was added to the list of converts and low-carb advocates. I don't claim to manage it all the time. Not in the least because sometimes a big plate of carbs can be just as therapeutic as the perfect blood sugar. But I try where possible to pick low carb options and where we are eating a meal with things like pasta and potatoes, I try to have the tiniest amount possible. This helped me get it to 7.9%

But the final (and unfortunately most problematic component) was the fact that two months ago I was invited to take part in a trial of the new Medtronic Enlite sensors and within just three weeks of wearing the sensors, my average blood sugar had dropped from 8.6mmol to 7.4mmol, and my control had tightened immensely. So when my blood was taken for the HbA1c this week, I had been lucky enough to be rocking the three things I think are key to a good HbA1c.

This time, it was 7.1%. Marvellous.

Unfortunatley I no longer have the CGM to help me on my journey, but once the little fan-fare had finished playing in my head and my Oscar -style speech was over, it still sank in that it IS possible to reach that number.

I just have to prove it's possible without CGM now!


  1. Congrats Anna, that's brilliant! Although I disagree with you on one thing - the pump is just a fabulous tool, it was you that made the difference to your HbA1c by making the most of it. Great job you!

    I live in awe of low carb/high exercise. Every braincell I have knows that is the way to go, it's just that they haven't yet communicated that to the rest of my body in a way that it can be convinced to forego pasta and get moving more!

  2. impressive :) and nice to hear someone admit that it hasn't always been easy. i'm still dreaming of seeing a 7 point sthg A1c :)

    1. Oh hell it's not easy. Sometimes it makes me crazy, obsessive, and very very shouty. But even without the CGM I am managing a 7.2% at the moment, so it is possible.

      Have you don basal checks? That was part of it for me too


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