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Friday, May 23, 2014

A1c Accuracy

"So how have you been?"

A seemingly innocent question asked by my endo as she sat down across from me. I never know quite how to answer this. I've been good. Really I have. My new job is going well, I'm enjoying living on my own in my new apartment, my weekends have been filled with fun events with my friends. I've been trying to get back into working out, I've been getting better at cooking and trying new healthy foods, things are good. But that's not really what she wanted to know.

"I've been good."

"How have your blood sugars been?"

Ah now we get to the real question.

"Have they been high, low, are you having any problems, do you notice any patterns?"

"Shouldn't you know?" I thought, assuming that she had at least looked at my graphs and A1c (which in fact she hadn't since they were still being downloaded).

"They've been high lately, higher than I want, but I haven't really noticed any patterns."

"What about lows?"

"Yea I have them after the highs, probably from over correcting. Lots of roller coasters."

We talked a little and made some adjustments and she got ready to wrap up the appointment.

"I was just wondering, what's my A1c?"

"Oh I hadn't even looked yet. (Ummm what, why not?") It's actually pretty good, 6.9."

"Seriously? Are you sure?? That doesn't make sense." My doctor turned the screen so I could see it on the computer. I looked at her perplexed. "I'm shocked, are you sure that's right?" It's not that I didn't believe that it could happen, after all almost exactly a year ago I was at 6.7, but I know what my blood sugars looked like then and I knew how they have been the past couple months, and something just wasn't adding up. But I was hoping that maybe I was wrong. Maybe I was just remembering the worst of the past few months and in general I was doing pretty well. "I want a re-check," I joked.

"Yea I'm pretty surprised too, that doesn't really make sense based on these graphs."

I'm not going to lie, I kind of wanted my doctor to prove me wrong, to not agree with me. To point to some trend or something that showed that I wasn't as off as I thought.

"We'll have them test it again."

In the 13 years that I've had diabetes and the over 50 A1c checks that I've had, I never really had a reason to doubt the accuracy of the test. But here I was, getting my first recheck. As I sat there waiting for the nurse to come back with the results I debated in my head whether it was better to be right or wrong in this situation. Right in that ordering another test was the correct decision, that the first result wasn't accurate and that I know my numbers and my body. On the other hand, I was hoping that I was wrong. That I was doing better than I was giving myself credit for, that maybe my A1c was 6.9, a number I've been working to get back to.

The nurse walked in and I looked up expectantly.

"It's 7.3."

"Yea that makes more sense."

Slightly disappointed that I wasn't 6.9, I was still okay with that number. It's been where I've been stuck at for the past 9 months so at least I wasn't doing any worse. Okay, 7.3. it's not my best, but it's not my worst. I said the number over and over in my head...and then I let it go. I'm trying to use my numbers to guide me, but not get caught up in them. So instead, I thought about what I need to do different between now and my next appointment in 3 months. Rather than focus on the number itself, I thought about what I can do so that the next time I see that 6.9, I won't doubt its accuracy.




6 comments:

  1. Brave of you to ask for the retest. Great attitude going forward. Good luck in 3 months!

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  2. How strange that the numbers differed so, minutes apart! I'm glad you asked.

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  3. Interesting - so, these two A1Cs were done at the same appointment? If so, that's pretty mind-blowing to me. I mean, I've heard that A1C isn't as reliable as we're led to believe, that it doesn't account for glycemic variability and can really be skewed by Highs or Lows immediately preceding the appointment/A1C check. But haven't heard of a result varying by almost a half a % point between checks so close together? Makes you really wonder about it overall... Anyhow, still. Congrats! Way to go on doing better and being in such a great place overall, and no matter the number knowing what it means on the path forward.

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    1. Thanks! Yea those checks were about 35 minutes apart. It's pretty mind blowing to me too.

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  4. Crumb! Why were the two tests so, so different?

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  5. Aw, that is interesting....I had an A1C result about 6 years ago that I was shocked by...it said I was 7.1 but my blood sugars were ranging in the 200's so I had no idea how that was possible but my doctor seemed to think it was fine (didn't have a CGM then)...I still don't think it was accurate and I wish I had asked for a re-check but it was my best ever A1C so I didn't want to question it too much :-P

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