Methods for charting A1C

I’m a LADA patient, am awaiting my first appointment with the endo, abd want to supply him and my healthcare team with as much information as possible for them to properly treat me. With this goal in mind I’m charting my blood sugar both eith an Exccel spreadsheet and the MySugr app.

From this I estimate my a1c at eirher 6.3 or 6.9 depending upon whether I use the DCCT chart or the ADAG chart. Which one should I be using?

I’m averaging at least 10 checks a day with finger pricks, usually more. Is this sufficient?

Hi @RobFoshee and Welcome to Type One Nation. I think to be exact you can use either and reference which calculation you used. Now 10 finger sticks per day can be tricky, imo, are you adequately capturing after-meal blood sugar rises? Are you testing on a time schedule or an event schedule? You know, the standard of care is to do a blood draw and read hba1c from the blood test. It is possible for that test to vary from your estimate. Good luck anyway!

Congratulations on your hard work in preparation for your visit. I’m usually pretty good at figuring out within a couple of tenths of a point where my A1C will be. When all is said and done your doctor will order the test to get the official results and you can use whichever scale they use as you try to gauge where you fall in the future - I hope that makes sense.
I wish you all the best at your visit and hope your doctor is a good fit for you. I’m sure they will appreciatr your diligence - I know I do!

Robert @RobFoshee, estimating HbA1c from fingersticks, no matter which comparative scale you use will be tricky with only 10 results per day. Personal experience over time, if you continue to do your BG checks at the same time every day - relative to your meal timing will help you. I did what you are doing for a few years before starting with a CGM and kept track and got very close guess to what my lab A1c would be; I think my guessing was because those were when I was working and had regular activity except when on travel.

Now, even with the 25,000+ BGL CGM readings every 90 days, I find my lab HbA1c to be about 0.5 percentage points, in the mid 5% range, lower than what my cumulative glucose readings indicate it should be. Just this week, I had to “comfort” a doctor who was reading my lab reports and got concerned that my 5.5% A1c was too low - I explained to him that my readings are low because of my red blood cell turnover rate. In the 1970s during development of what is now called A1c, my “scores” didn’t fall under the expected statistical curve.

Good luck with learning effective management skills for your diabetes - like me, I see you are managing by making this your personal “science project”.

@wadawabbit Thank you so much for your support and encouragemen!!! Based upon my research the tools the endo practice has they look like a good fit.

@joe I’m probably not getting all of the immediate “spikes” that probably come immediately after meals. The primary care dr is okay with three tines a day, at breakfast, lunch, and dinner. Frankly that’s not nearly enough!!

This is not meant as a slight to her. As seems to be common, she lacks fundamental understanding of LADA. She and I do agree that the case needs to be referred to the appropriate specialist.:grinning:

My current testing patterns are as follows: 1.) First thing in the morning, 2.) 1 hour after breakfast, 3.) 2 hours after breakfast, 4.) 3 hours after breakfast, 5.) before lunch, 6.) 1 hour after lunch, 7.) 2 hours after lunch, 8.) 3 hours after lunch, 9.) before supper, 10.) repeat the sane hourly ptocess as with the other meals, and finally 11.) bedtime.

This isn’t exact as I have a VERY busy work and family schedule meaning if the results are acceptable after 1 hour I may skip hour 2. Also, if hour 1 results aren’t within range I will do more often. If bedtime results aren’t good and I’m exhausted I’ll set an alarm to test again later.

As a LADA, I know barring supernatural Divine intervention eventually my insulin making process is going to fall and when I don’t know. Therefore I must be prepared!! I’m probably not getting after meal “spikes.”

The targets I’m using are as follows: 1.) fasting in the norning of 100 to 125, 2.) 1 to 2 hours after eating less than 180, 3.) betwern 70 to 130 before meals, and 4.) less than 140 at bedtime. I almost never hit target 1, I usually hit target 2 within 1 hour about 90% of the time and 99% of the time within 2 hours. Now I’m almost always hitting targets 3 and 4.

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@Dennis This is encouraging!! My actual A1C could be lower than mu calculations!!

“Science project” is a good description. Our lives depend on getting it right!!

Have you considered getting a CGM? It will let you see what’s happening between the fingersticks you are doing now - including anything that might happen overnight.

@wadawabbit I’ve been thinking about this and have been researching them. Getting the endo to prescribe one is at the top of the to do list. Right now I think I want the Dexcom G6 but haven’t decided yet. Hopefully my insurance will cover it.

I had been apprehensive about wearing something. I think I better get used to it now and it’s a much better option than finger sticking in so many ways I wouldn’t kbow where to start!!

Another thing I like about the team on paper at least is they have a team member who is listed as an expert on insulin pumps. There’s also a dietician. After meeting the endo the goals are an appt with the dietician to fine tune my diet. Then to work with the insulin pump team member to gain a thorough knowledge of these so I’m ready to adjust in “real time” when I need it. Right now the Omnipod 5 System looks like it has the most potential but it’s new. It looks like they’re still working out bugs and customer service is a nightnare!! If needed in the near term, might have to go with a “tried” approach. This is an area where the pump expert shouid be able to help!!

I love my G6 and don’t notice it, although I’ve been using it for years and don’t recall if that’s how it started.
Freestyle Libre makes the other CGM and I keep one as a backup just in case. I personally have found it to be just as accurate as Dexcom although that’s not the case for everyone. But if it is accurate for you and you’re not on a closed loop with a pump, then in my personal and decidedly non-medical opinion it’s a great alternative, and much less expensive; and it could be a good starter - they come individually rather than in boxes of 3 as with Dexcom, so you won’t be wasting product or money if it doesn’t suit your needs.

@joe Here I was feeling good about myself about generally hitting the targets I discussed in my previous reply to you. I sure missed it at supper!! I tried tweaking something I’d tried before, got distracted, and didn’t check BG for 2.5 hours. To my horror the BG monitor read at 232!! Based upon prior experience I think I topped out at between 240 to 250. I hadn’t seen numbers like that in over a month. Fortunately its coming down. Last reading is 199. I’ll keep monitoring to make sure the trend continues.

I’ve learned from here and elsewhere that this happens to even the veterans!! I’ll try not to beat myself up over my oversight!! Tomorrow is a new day!! CGM you can’t come soon enough!! Thank you all so much for your support!!

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@wadawabbit thank you for the info on CGMs. My research on these is ongoing. I’m going to want significant input from the endo team regarding this as well.

I didn’t address insulin pumps before. My first pump was Minimed 504, which I got back in the mid 90s; and I had the next 3(?) generations before I switching to Tandem several years ago. I have been using Control IQ with Tandem for over a year now.
My Tandem warranty is about up and it seemed like a good time to try Omnipod 5 - there’s no commitment with Omnipod so I could do it any time, but the timing just seemed logical. I have my training session on Thursday evening and will make the switch then, and I’m excited although I have read about the issues. Many reviewers said you may run high with the first two or three pods, as the system learns to read your body - but I didn’t see anything from those same users about how well it worked after the adjustment or if they gave up; so I’ll have to see.
If you decide to use a pump I would suggest starting manually and using it that way for several weeks before upgrading to CIQ (or BIQ): I’m a big believer in “going old school” which in this case means knowing how to manage on your own before letting technology take over. Just something to consider.
Given your vigilance it sounds like you’re doing great on injections. Some people truly cannot stay in control on shots and a pump is a necessity. Others do fine with them but prefer the convenience and possibility of better control that a pump can offer. But some people do better on injections. I believe I read that A1C increased at least slightly for some who went on a pump (@Dennis ?). For me it’s easy to pop a snack and cover it with a bolus, but even so there is going to be some rise. With injections you may forego that snack if you have to pull out your pen. That’s my theory anyway.
I don’t want to dissuade you - just giving you something to discuss with your doctor so you can determine whether a pump will help you meet your goals. If I were on injections now and considering switching to a pump, I don’t know that I would even think to ask about it if I hadn’t read about it on the forum!
One final thought (for now😉) - check out the book Think Like A Pancreas. Gary Scheiner, the author, has Type 1 and works in the diabetes field so he has a truly unique perspective.

@wadawabbit thank you for the info on CGMs. My research on these is ongoing. I’m going to want significant input from the endo team regarding this as well. I’m s

@wadawabbit thank you for sharing your persoectives on pumps. I pretty much agree with you. Start in manual mode first. I’m a big believer in “old school” as well!!

Robert, that is a wonderful attitude and what I believe is the path to a good life. It may be good to have a “target goal” for the various blood checks [not tests] we do daily and periodically like the HbA1c, but that is not my way of living. My goal is to live a full, active, productive satisfying life while managing my diabetes to fit my lifestyle. My first couple of decades with diabetes were “a wreck” but then I was motivated to get things in hand and have now moved into the latter half of my seventh decade using insulin of one type or another to stay alive. After reliable fingerstick meters finally came into existence, and now CGM, I use the readings as signposts or directional arrows to assist me in adjusting the course of my body glucose levels - to only goals I set is to remain as much as possible in safe range that permits anything I want, when I want and remain healthy.

Autoimmune diabetes, in recent years morphed into being called TypeOne, is autoimmune diabetes no matter whether diagnosed at age three or at age 78. In recent years, the largest grouping of newly diagnosed is the age 20 through age 39 bracket. The “LADA” tag just adds an extra tag for doctor billing; my thought is that the “L” in lada means Lucky. Just think, you at your age and comprehensive skills are in a position to manage your diabetes much easier and more effectively than a child of age three. Also, you are not a teen reble, as I was, in denial.

Keep up your good work, your targets and your success rates are really impressive. You don’t mention carbohydrate loads of meals, I only hope that you allow yourself freedom to eat well and continue to enjoy meals like those you ate in the past. I enjoy eating, but now only consume an average of 230 carbs per day.

For me, Dorie, I was able to slightly increase my A1c when I began using a pump and at the same time, narrow my standard deviation. My intent when beginning using a pump was not to lower A1c which hung consistently around 6% with MDI, but rather to get away from 2,00 needle pokes a year. I still watch Standard Deviation, but now lesser than TIR which is readily apparent with a CGM.

I’ve spoken with people who claim that a pump didn’t work [for them] and that A1c went higher, but I haven’t seen any studies indicating higher A1c with a pump. Of course, manufacturer marketing/advertising campaigns always claim that a pump lowers A1c.

@ Dennis
@wadawabbit

Thank you so much for your encouragement!! I suppose the “L” in LADA could be lucky. I do thank God daily that this has been caught early and I’m not having to suffer for years with a misdiagnosis!! The horror stories associated with misdiagnosis are truly heartbreaking in terms of the mental and physical toll they place on the patient and their families are heartbreaking!!