Emails can be interesting and have some
of the most difficult questions to answer. Like Tom Ross (page down to Feb 26), I do get
questions about what do I recommend for an A1c. I can only reply,
what is your tolerance level? Or, the question will be something
about the point on the A1c scale that prevents diabetes
complications. To this, I always respond there are no A1c levels
that will prevent complications, only reduce the risk level for
complications to develop, unless you die first.
Most people do not understand what I
mean by tolerance level. They are looking for numbers that they can
remember and have as a goal. I then need to remind them that I could
give them numbers upon numbers, they would not be able to achieve
them, and they don't believe me. I ask them what their last three
A1c readings were. I will use an example of 5.8%, 6.1%, 5.6%. In
this case, it is a total of 17.5. Now divide this by 3 and the
answer if 5.83%. Now if you are lucky, you might be able to obtain
the next A1c of 5.8%, but most people will not. This person said she
would not even try, as she wanted to go lower than the 5.6%. She
actually did achieve an A1c of 5.3% for her next A1c.
This is an excellent A1c and some
people are able to get this. She is following Dr. Richard
Bernstein’s “Diabetes Solution” and hopes to obtain 5.0% and
maintain the level within a few tenths. That is her goal and
tolerance level. She does not wish to be above 5.2% after that.
My tolerance level is not to get above
6.5%. I have bounced all over the place and don't like this.
Generally, I am between 5.9 and 6.6%, but have had lower and higher,
but for the last two years, this has been the range. One doctor has
emphatically told me to bring it up above 6.5%. I said that was not
in my tolerance level and I wished to be closer to 6.0%. When he
persisted, I asked if he was asking me to leave his practice. He
claimed he that he was not, but for my age, this is where he felt I
should be. I did tell him that I did not appreciate him pushing me
to speed up the development of complications and that next time he
said to bring my A1c up, I would not be back. We will see what
happens.
Therefore, if you want to think of
comfort zone instead of tolerance level or risk level, that will
work. Everyone has their comfort zone they wish to maintain and this
is good. I do encourage not being above 6.5% and the younger you
are, the lower your comfort zone should be. I don't know that I will
ever be comfortable above 6.5%, even as I grow older, but I will
cross that bridge when I get there.
The higher the A1c level, the higher
the level of risk you are willing to endure with diabetes. You are
always at risk for development of any complication, but the closer
you are able to maintain your A1c to the normal for healthy people,
the less risk you are under. The recommended A1c of 6.5% by the
American Association of Clinical Endocrinologists is not ideal and
the risk level for diabetes complications is higher than an A1c of
6.0%. I do not understand why the American Diabetes Association sets
their recommendation of A1c at 7.0%.
The table of the estimated average
glucose (mg/dl) to A1c% is here and I suggest that you use the
table to aid you in finding your comfort zone. The medication(s) you are on will also help you decide the risk, tolerance, or comfort
level you wish to have as your goal.
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