February 20, 2012

Our Goals for A1c

Maryam Elarbi writing for Diabetes Self-management had a very well thought out blog about A1c goals. As one of the readers commented, How mature of you to take this attitude!” And for a young person with type 1, she could not be more right.

Often, we read about young people her age that are off to college, completely coming at odds with diabetes and letting diabetes take a toll on their health. And then in later life realizing how foolish they were back when.

Maryam's blog is worth the time to read. Before I get to what I wanted to say about A1c goals her statement here is most important, “At 18 years old, I’m finally at the point where I understand that “being good” at diabetes isn’t for my parents’, CDE’s, or endo’s approval. I’m accepting the responsibility that I need to take the best control of my diabetes for me.”

Now how does this apply to type 2's? I can no longer say that maturity gets us to this point quicker when we develop diabetes in our later years, too many young people are now developing type 2 in their preteen and teen years. They are facing the same type of problems this type 1 has, accepting responsibility for their diabetes.

Denial is an ugly part of our lives that needs conquering, not only to get on with life, but to take care of diabetes and prolong life. Some get stuck in denial for periods long enough that the complications get a strong foothold on our bodies and recovery is impossible. I actually thought I was immune when denial did not happen shortly after my diagnosis. Yes, I had the anger of getting diabetes, but I knew that my family history said I was at very high risk.

It was not until the third year that I had any denial. I was on insulin four months after diagnosis and quite happy with the success I was having. My A1c's were improving and I was living with diabetes. I think that denial maybe came with the depression of dealing with diabetes 24/7. Or maybe it was a little self-blame. Again, I was fortunate that this did not last long and I was back to myself again. I must also give credit to starting my second marriage shortly before the denial/depression happened.

The American Association of Clinical Endocrinologists (AACE) recommends A1c's of 6.5 for the upper limit and in 4 of 5 times I will be under their limit. It is that fifth time that seems to grab my attention. I have, since shortly after my diagnosis, been able to maintain my A1c below 7.0 and a few times below 6.0. I had wanted to get below 5.5 regularly, but that has not happened.

As I continue to age, I have reset my goal to keep my A1c near 6.0, which has worked out very well. I have learned the hard way that if you set realistic short-term goals and can achieve them, then the long-term goals will generally take care of themselves. Yes, you may have glitches (or bumps) along the way, but you will not fail to achieve the short-term goals if they are realistic and well thought out.

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