Monday, November 20, 2006 | 12 comment(s)
I knew going in to the test that my glucometer readings were not all that different then they were before my last A1c
The most striking difference is that I've cut back the number of times I'm testing from almost 20 to just over 12 times per day. Other than that, the differences aren't all that significant, so I really didn't have any right to expect a lower A1c result on this test.
Alas, it wasn't meant to be. My reading was a 7.1 -- unchanged from my previous reading in June.
I was completely deflated when my endo gave me the result.
My disappointment quickly turned into anger (which is really, really rare for me), and I became rather argumentative with my endocrinologist (who I haven't always gotten along with before). We then had a pretty heated argument. I was on the verge of storming out of the office at one point and she was on the verge of tears at another. It wasn't fun.
I tried to explain to her that criticizing me for having a "normal" range of 80-160 in my graphs is NOT constructive. She thinks that if I had the top of my range set at 140, I would have better control and perhaps lower my A1c. I, however, am absolutely certain that where my target range is pictorially is not at all correlated with my A1c readings. In fact, I think having too narrow a target range is counterproductive, actually. There's nothing that frustrates me more than seeing a cell in the OneTouch database all shaded red for a reading of 124.
124?!?!That's a damn fine reading in my book! Regardless of the time of day! (That's why I created my own logbook and record things how I like 'em).
She went on further to point out that I should be waking up with all my blood sugars between 70 and 100. That when someone is in the hospital, they try to keep all blood sugar readings below 110 (thanks, that's not very relevant right now, but I'll try to remember that the next time I'm hospitalized). That people with fasting blood sugar readings above 110 are being labeled "pre-diabetic" these days (again useless, NB: I AM ALREADY DIABETIC, NO "pre-" ABOUT IT!). And that I shouldn't have any post-prandial blood sugars above 140. She told me that while I think 70
I think to myself"Of course she thinks 70 is a normal reading, that's because she's never been down at 50 or 40!"
I expressed my confusion about the relationship between average glucometer readings and A1c results (like I've done before) and showed her the trends in my averages by time of day, and she actually told me that averages were not important, but that it was more important to focus on abnormal, individual readings in my logbook.
"Look here!" (she exclaimed while circling a peak on a line chart)
"Why were you at 256 at 10:30am on Monday last week?"
I DON'T KNOW! (Capitalization does not adequately express the decibels I'd like for that to be read at).
What is this? The Spanish Inquisition?
Averages are what it's all about, in my book. And standard deviations too.
Toward the end of our appointment she told me not to focus so much on the numbers. That I'm a "model diabetic." That I'm doing well. And that I need to relax and not get so stress out ("Stress will raise your blood sugar levels" she so "helpfully" tells me). But what's the point of giving someone a goal and to then telling him/her not to worry about the numbers!?
She said I'm being a perfectionist.
Perhaps I am. So what?
Is that a bad thing, really?
Shouldn't we strive for perfection?
Isn't that what we are told (either implicitly or explicitly) to do?
And believe me you, there were 27+ years of my diabetic life where I wasn't a perfectionist, so I've got some makin' up to do!
Perhaps I'm overly obsessed with the numbers, but I can't help it. I'm an empirical kind of guy.
After a few days of thought, the dust has settled, and I've calmed down, I get to thinking:
On the one hand, 7.1 is NOT a bad A1c reading at all.
But on the other hand, that doesn't help ease my disappointment all that much.
I'm just so disappointed that I put forth all this effort and still wasn't able to hit the goal that was set out for me (thank you ADA & AACE), and that I more than fully took on. I feel like I failed.
But if I honestly ask myself: "Are there things I can improve upon?" The answer is a clear: "Hell yes."
But to what extent do I take it? When does the effort expended testing and logging blood sugars, counting carbs, denying food cravings, worrying about exercising, and working to be the "perfect diabetic" really start to diminish one's standard of living? Is it worth it? How can one know?
It's a matter of balance, for sure. But when do you say: "Okay, I can do this. I can sustain this level of attention to my diabetes, attain this level of control, and live the rest of my life on my own terms." Everyone comes to this equilibrium on their own terms, whether consciously or unconsciously.
Looking back on this year, I've made a lot of changes in my diet and carb counting, I now have accurate basal rates set in my pump, I'm exercising regularly, and these are clearly beneficial, and I should be proud of these achievements. And I realize that having consistent readings in the low 7s is a LOT better than the past 10 (or more) years of readings in the mid 8s.
But I think my game plan for the next year (starting now) is to attempt to take it up another level.
I have to get to an A1c below 6.5.
I have to know what it takes to achieve that goal.
And then I'll have to decide whether that kind of effort is something I'll want my life with diabetes to be like.
It may be that being that strict will be a completely miserable existence, and it just may be that 7.1 is the level of control that suits my equilibrium. I won't know for sure until I get to the other side and see what it's like there.
I'll be sure to keep you posted...