annual a1c and brain weasels

[Amyfaith]

Hi all,

Been a while - busy term, so not been around much. Got a message from my GP the other day to book my annual diabetes check, which of course I'll do (when I have a free moment - I'm genuinely booked up for the next MONTH). But the brain weasels are starting regarding the a1c, because a) it's after Christmas and b) after stressful stuff over the Christmas period.

I wasn't indulgent at all over Christmas (my version was half an (American) biscuit with Christmas dinner plus a few more bits adding to more carbs than I'd normally have in a single sitting - 90g rather than my usual ~30, but that was a single meal), and though my finger pricks were a little elevated at home, that was partly due to less opportunities for moving my body, jet lag/FOTF, and also just a different glucometer (bought one stateside to be sure I'd be able to get strips). Average over those three weeks was 5.6 rather than 5.3, so nothing massively different, and probably down to the different machine after the first few days once my liver caught on to my new time zone.

I know the a1c is not a moral reflection of myself, and I know I'm doing really well, at least according to my finger prick readings. I've also lost a little under a third of my body weight (100ish lbs/ 45kg from my highest weight), though I know that doesn't necessarily mean anything (and it's more annoying than nice, honestly. It'd be nice if anything I bought fit for more than 2 weeks because it's still coming off at roughly the same 2lbs/week rate!). My fasting numbers are sitting at 4.7-4.9 almost universally and seeing anything over a 6 after meals is rare. Even my little indulgence on Christmas day left me at only a 8.3 at the peak, and down to a much more reasonable 6.7 at 2 hours given what I had). But then I had similar finger prick results back when I had my last one done in June and it came back at 49, so I'm just a bit worried/perplexed/confused/anxious. It feels a bit like medical gaslighting because all the GP says is 'oh it's an average', 'oh you indulged over Christmas', or that I'm not testing at the right times, and like - yes, sort of, but also they make it out like it's the be all and end all and somehow I'm lying when I show them my glucometer apps with a lot of frequent testing, and often just at random times to try to catch unseen highs/lows. It's just frustrating and it's making me anxious about the whole thing. (Not stopping me from scheduling - that is genuinely my workplace and workload over the next few weeks and my GP not scheduling more than 4 weeks in advance!)

Basically: calm me down, tell me how to counter any GP silliness, etc. Thanks, everyone. x

 

[Lucyr]

You’re massively overthinking this. The a1c is just a piece of information to use as part of decision making I.e does anything need to change with medication, diet, exercise or not. That’s all it is. It doesn’t even make the whole decision either it’s simply one single piece of information to help.

 

[silver minion]

Your own readings look good and along with the weight loss should reflect on the HbA1c results. You have already gone from quite high at 85 down to just into diabetic range at 49 in a fairly short space of time so give yourself a pat on the back.
Have you thought of some de - stressing activities. Yoga or Tai Chi helps focus your thoughts and stops the brain running around the "what if" anxiety track.
As @Lucyr said the hba1c is just one of the checks to help you manage your diabetes.

 

[JimmyBlue]

@Amyfaith hi, I agree with @Lucyr and @silver minion , you can relax from what you have been doing your HbA1c is unlikely to be that bad. I too had a busy Christmas and may have overindulged a little bit but when I had my bloods done at the start of Jan, my HbA1c had come down from its heights.
I think the destressing activities might be worth a try, I took early retirement in December and currently I am feeling a lot less stressed and found managing my diabetes a lot easier, particularly in being able to exercise a bit more frequently.
The clothes not fitting issue is a major problem though as I am down from a 34 waist to about a 30 these days.

 

[JITR]

A biscuit at Christmas won't make a difference to A1c, a so called '3 month average'. You need to know the result. It will likely be below 49 (so just carry on). If not, the sooner you take corrective action (diet/exercise/lifestyle) the better.

I had a test last week. I'd got my A1c down from 104 to 32 in 6 months. Maintained it for a year, then it had shot up to 39 in the three months to September 2024 for no obvious reason. I was apprehensive about an upward trend to say 46-48. Result came through on Wednesday at 35. Relief.

 

[everydayupsanddowns]

I know the a1c is not a moral reflection of myself, and I know I'm doing really well, at least according to my finger prick readings. I've also lost a little under a third of my body weight (100ish lbs/ 45kg from my highest weight), though I know that doesn't necessarily mean anything (and it's more annoying than nice, honestly. It'd be nice if anything I bought fit for more than 2 weeks because it's still coming off at roughly the same 2lbs/week rate!). My fasting numbers are sitting at 4.7-4.9 almost universally and seeing anything over a 6 after meals is rare. Even my little indulgence on Christmas day left me at only a 8.3 at the peak, and down to a much more reasonable 6.7 at 2 hours given what I had). But then I had similar finger prick results back when I had my last one done in June and it came back at 49, so I'm just a bit worried/perplexed/confused/anxious

I completely understand the anxiousness that an impending HbA1c can bring, especially with the “called to see the Headmaster” vibe some Drs can add to it. Hardly helpful!

But the results you have shared look in an absolutely brilliant place! HbA1c can feel really important, but it’s not a measure without its own vagaries and flaws. 2 people with identical HbA1c can have vastly different glucose profiles, and very different levels of risk.

From my T1 viewpoint, I have the luxury of shrugging a little at my HbA1cs these days. They are really only a proxy measure for the Time In Range that my CGM gives me. And that’s a far more nuanced and actionable flow of data IMHO.

Hope you get a pleasant surprise when your results come in, and try not to get stressed in the meantime. You are doing really well. Keep it up!

 

[Amyfaith]

Sorry for all the silence - absolutely mad semester here (again, always). Not as much teaching but just endless marking and firefighting.... Always getting home meaning to write a thanks to everyone for their messages and just running out of time before needing to head to bed!

Just back from my vampire session and that's what made me think I should reply now anyway (still at work but it's reading week; they can deal).

I completely understand the anxiousness that an impending HbA1c can bring, especially with the “called to see the Headmaster” vibe some Drs can add to it. Hardly helpful!

YES. Exactly this. The GP I generally see isn't super bad for this, but the attempt at empathy can often come across as patronising as well. The circumstances surrounding my diagnosis haven't helped at all - the self-hatred and anxiety go through the roof. Which, um, has almost as big an effect on my BS levels as eating a meal. And for longer.

2 people with identical HbA1c can have vastly different glucose profiles, and very different levels of risk.

I keep reminding myself of this! Suspect I may need to remind the GP of it as well...

I have a funny feeling I have some mild sub-clinical anaemia and/or unusually long-lived red blood cells or something similar that's leading to slightly weird results. But the fact all my testing is giving me good stuff (my fasting numbers are in the mid-4s now, particularly since I got back from the US!). I've got my freebie Dexcom on at the moment and even if I don't get up and have a walk after dinner, I max out at 7.5 - if I even go that high. Goes down slower without the walk, but that's all.

A biscuit at Christmas won't make a difference to A1c, a so called '3 month average'. You need to know the result. It will likely be below 49 (so just carry on). If not, the sooner you take corrective action (diet/exercise/lifestyle) the better.

I think the thing with this is - what *else* could I possibly be doing if it has gone up significantly? (also, like, then what on earth is going on with my daily readings?) I know I'm dealing in unlikely scenarios here, and the reality is I'll probably be in the upper 30s/low 40s (app says bang on 30, and when I've used a CGM it gives me something in the upper 20s but that's with compression lows, sooooo...), but it's just, in the off chance it's gone up - what else could I possibly be doing? (cue brain weasels)

But anyway. Appointment with GP scheduled for about 4 weeks' time. Am sure if something comes back wild, they'll let me know sooner rather than later. Fingers crossed...

 

[Amyfaith]

Also, I FULLY intend to take advantage of not being likely to need another test for a while this weekend. Trying to decide what my ‘easing off the gas’ meal will look like already…

 

[rebrascora]

Look forward to congratulating you on your result when you get it. Hopefully just a day or two for the results. Even if it isn't quite as good as those BG readings suggest and they suggest a normal HbA1c you still deserve a massive pat on the back for your hard work and focus.... but I know a good result can really help to motivate you to keep going whereas a slightly less good result is always going to feel like a slap in the face even when you have done your absolute best, which clearly you have. Keeping fingers crossed for you.

 

[Amyfaith]

Look forward to congratulating you on your result when you get it. Hopefully just a day or two for the results. Even if it isn't quite as good as those BG readings suggest and they suggest a normal HbA1c you still deserve a massive pat on the back for your hard work and focus.... but I know a good result can really help to motivate you to keep going whereas a slightly less good result is always going to feel like a slap in the face even when you have done your absolute best, which clearly you have. Keeping fingers crossed for you.

Yeah, they’ll probably tell me they have results in under a week if it’s like last time, but I can’t work out how to see them without actually going to the GP…

 

[rebrascora]

Do you have the NHS app? Results should be uploaded on there I think.

I generally access mine via System Online which is my GP practice computer system where I also order repeat prescriptions.. You have to ask at your GP practice for access to that and they provide you will a username and password to access it.

 

[helli]

Yeah, they’ll probably tell me they have results in under a week if it’s like last time, but I can’t work out how to see them without actually going to the GP…

If you are based in England, your GP should provide access to your records.
For most of us this is available via the NHS app. And it will show the results of your blood tests without needing to see the doctor.

 

[Amyfaith]

Would you know it - every time previously that I’ve logged into the app to see if I have records, it’s come up empty. Do it today and it’s all there! Huzzah!

 

[saffron15]

@Amyfaith I haven't signed up for the app yet but I asked receptionist my hba1c result on Christmas Eve. I had to go in the surgery for a blood test anyway but in my surgery you can request a result on their website. I'm super impressed your seeing a GP doesn't happen in my surgery.

 

[Amyfaith]

@Amyfaith I haven't signed up for the app yet but I asked receptionist my hba1c result on Christmas Eve. I had to go in the surgery for a blood test anyway but in my surgery you can request a result on their website. I'm super impressed your seeing a GP doesn't happen in my surgery.

Yeah, I mean, usually need to wait 3 weeks or so, but you can generally get someone. It’s the university’s practice so an army of GPs (also an army of patients), but it’s not like trying to share 3 GPs or anything. It’s one of the reasons that while I have occasional GPs I don’t like, I haven’t switched to another practice. At least you could ask the receptionist - I feel like ours might just quote GDPR regs!

 

[Amyfaith]

The results are in - and! - 35! Gobsmacked that it's actually pretty close to my finger pricks (saying 30.5).

(total cholesterol ever so slightly high at 5.1 but I'll take it given the last results on that were well into the 6s and I'm a fan of cheese...)

Thanks everyone for helping me calm down the brain weasels.

 

[rebrascora]

Many congratulations! That is an excellent result. Delighted for you.

 

[silver minion]

Brilliant result @Amyfaith
So pleased for you. Set those brain weasels free and look forward to a healthier 2025.

 

[Amyfaith]

I did of course order a handful of Dexcoms over the weekend. Might save them for random checkpoints throughout the year rather than having to fight with the GP going ‘yeah but my arm buddy says THIS’.

 

[Flower]

Congratulations on your excellent result @Amyfaith