Slightly disappointing HbA1c

[Abi]

Just got it back- 57 ( 7.4 in old money)
Previous 2 were 55 (7.2)
I'm a second time round pumper and some times had better HbA1cs on MDI but with more ups and downs- affecting mood- only got very good control when lower carbing ( and I'm a skinny runt and like my carbs) because of not being able to match basals accurately so large inputs of carb and rapid insulin caused problems in either direction.
I was hoping for a better reading this time round. I had a bit of a rubbish month in August- diabetes decided to take a holiday for a few days for no obvious reason so my basals plummeted but then went through a period of overnight highs and I was fairly conservative at adding back more insulin as did not want more hypos
I'm always a little concerned that in todays economic climate there may be an argument to stop pump funding unless HbA1c is perfect or a measureable improvement on pumps over injections ( in my view I am better controlled as my highs are lower and my lows are higher)- in order to save money
I'm not one of these people who thinks that anything over 6.5 is a disaster and I have survived 26 years of D with only minimal background retinopathy in one eye but I would be delighted to shave off half a percent or so from the HbA1c
I use a Bayer meter. According to the control solution it is in acceptabel range. On several fora suggestions have been made that this meter gives lower readings than some others. I wonder if changing meter would help my situation but on the other hand I don't want to run the risk of not detected hypos just at the lower end of normal range and cause problems with my driving license, or run too low at work as the obligatory 45 minute recovary time would put me way behind if I went low at a time when I need to drive. In addition according to Bayer meter I do have a fair number of mild lows but rarely below 3- it may be that these are not true hypos at all
I have an old one touch 2 and a one touch ultra meter and am wondering whether to go back to these.

 

[Abi]

When I was on the pump first time round I was using one touch ultra and achieved several HbA1cs in the 6s- eventually drifted up into mid 7s due to major lifestyle changes and not trying hard enough with e.g. fasting basal checks. In fact HbA1c has been higher than I'd like since I went onto the other meter - which I was given as it has the "link" function so can give the reading directly to pump- which I never use. The more I think about it the more I feel I should perhaps change back to one touch ultra. Having 2 machines compatible with this strip I will ask at my review tomorrow. If a meter is reading say 20% low than an average of 7 could well be an average of 8.4 so I'm sure this could have some influence on overall reading

 

[Northerner]

I think that, given what you have said about the problems you have encountered in recent weeks, you have done very well to maintain your HbA1c so close to previous ones 🙂 I'd like to believe that there will never come a time when a pump would be taken off someone based purely on a marginal HbA1c difference - the smoothing of the numbers/spikes is surely an equal if not greater indicator of overall improved control.

Can't really comment on meters as I have more or less used a Accu chek Aviva since diagnosis (only 4 years for me!). I do occasionally use an Optium Xceed and suspect this gives me slightly lower readings than the Aviva, but don't really use it enough to be sure.

 

[Abi]

Thanks for that.
I'm not sure that the odd reading in the teens or 20s would make a difference but slightly higher ones of say 8 to 10 may - especially as I was settling for these for reason's already explained ( and the 8-10 may have been more in the > 10 range if meter reads low)
Someone posted an article recently re meter inaccuracy more or less saying don;t get too uptight about it as there are so many other errors- but a 20% difference in monitored and actual levels would surely influence HbA1c.
I attained an improvement of 7.1 initially on pump this time round- from 7.4 at the same time as breakup of a 5 year relationship- moving back in with parents- no work ( actually a welcome break as no financial worries) but the weeks before the relationship had ended were horrendous in terms of stress and high bsls. Now I'm happy and settled so control should be better.I was using the one touch when I achieved the 7.1. I know there are other factors and diabetes can change - I've become ridiculously insulin sensitive only needing 7 to 9 basal per day and this in itself can mean it's more easy to swing up and down
LOL at first post . I said highs were lower and lows were higher- the reality is that both may be higher

 

[everydayupsanddowns]

Sorry to hear your A1c has gone up a tad Abi, though like Northie I would be very surprised if you got any grief for it regarding keeping hold of your pump. One of the criteria for pump funding (infact the only one that applies to you since your A1c is below 8.5%) is to reduce the number of hypos/BG variation and improve quality of life.

I also changed to the Bayer ContourLink some months after I started pumping to get the benefit of the Bluetooth functionality, and while checking the accuracy of another meter (which seemed wildly out for me) against my old Accu-chek I did notice slightly lower readings generally (though usually within less than 0.5mmol/L). Wrote a blog post about it if it's of interest (skip down to the bottom for the Contour/Accu-Chek comparison).

Mike

 

[Pumper_Sue]

Hi Abi,
considering your life style and how unpredictable your work is, I think that's a good result.
You like most type 1's are also running scared of a hypo and having to take a break from driving for 45 mins which means sub consciously you will tend to run slightly higher during working hours.
I use the one touch meters and have found they do correspond with my A1c, so perhaps a change would help as well.

 

[trophywench]

Hmmmmm.

My A1cs were nearly as high as my meter averages, I never realy gave it much thought. I loved my succession of One Touch meters - was using an Ultra 2 (my second) when I went on the pump.

Because it's the Accu-Chek and the remote/bolus wiz is on the Combo meter, I reluctantly changed to that meter. Reluctantly because it usually read lower than the One Touch. I had a right old whinge about it over on t'other forum ......

Amazingly my A1c dropped ..... I can only conclude that the One Touch was reading lower than it should have been because other than the obvious basal differences, really I haven't done all THAT much different. And yes I did check it with control solution but the range is so vast it could make quite a difference to your A1c.