Tuesday, October 15, 2013

Delicate Balance . . . . .

Friday morning I headed to my endo appointment.  I have a really great endo, but I’m still a bundle of nerves as my appointment approaches.  What if I’m not doing as well as I think I am?  What if something comes back floopy in my labs?  Even though my appointments have been going great for a while now, I find myself always waiting for the day I get a really bad surprise.  And I’ve decided I’m okay with the nerves, because it means I still care.  And caring about diabetes is a big part of the battle.

I love the bright open waiting room at my endo’s office.

So there I was, weight and blood pressure taken (both are higher than I’d like) and pump information uploaded.  Paperwork for a new 530G with Enlite filled out.  A new script for my blood pressure medication electronically sent.  We turned to my labs results and pump reports.  Liver and kidney tests are perfect.  Cholesterol is excellent.  Vitamin D is finally in a good range.  And then . . . . . my A1C . . . ..  hmmmmmm.  We take a look at the blood sugar graphs from the pump and CGM.  Hmmmmmmm.  Mostly good.  We discuss some of the big spikes and both agree that they don’t warrant any basal changes - just some tighter carb counting and acknowledgement that hormones throw my overnight numbers out of whack for a few days every month.  We agree that those highs aren’t too much of a problem.  The real concern during this appointment is the lows.  Lots of lows, especially between 2 a.m. and 4 a.m.

This all leads to a sentence I never ever though I’d type.  My A1C is too low.  Sounds impossible, right?  Sounds like a fantasy.  It’s not.  After decades of beating myself up for having a high A1C, of working so hard to bring it down and feeling like I always failed, I now have to worry because it’s too low.  And it feels like just as big a failure as my too high A1Cs.  It means I spend way too much time with hypoglycemic blood sugars.  It means my health is at risk - perhaps not from the complications I was threatened with during those years of highs, but with the fact that lows can stress my body, specifically my heart.

So here I go again.  Instead of working to bring down the highs, I need to focus on avoiding lows.  I’ll be honest - it’s completely frustrating.  It feels like no matter how hard I try, it’s never enough.  I’m chasing a delicate balance I’m not sure I can ever achieve.  I still care and I’ll still work hard, but my goodness it is exhausting.


  1. No matter how much we say we don't and no matter how much we know we shouldn't, we all use that A1C as a judgement tool for how we are doing. My daughter had a GREAT A1C at the last appt and I fear this appt on Thursday we will have a terrible A1C because her numbers have been high over the last few weeks because of illness.

    We just have to remember that we need to take it one day at a time and bad days are OK and we are all doing OK.

    You are doing great. And thank you for sharing! Hope you get those lows to cooperate!

  2. I'm approaching my check-in soon too and have the added nerves of dealing with a new doctor. Hope she won't pass the same judgment as the last guy I went to (and will never see again) who labeled me "uncontrolled" for a 7.2. This was after years of acceptable levels and a lot of stress (moving, new job, etc.) and he started the appointment by complaining about how expensive all my medications were. I hope the new doc isn't the same ��

  3. I struggle with hearing a doctor say your A1c is too low. Is it lower than a non-diabetic's A1c would even be? If it's "in range" with that is considered normal for a non-diabetic, why can't we expect that too?

  4. I am starting to believe that when I reduce my extreme highs, I also reduce the number of severe lows. So a lower A1c is not always the result of too many lows. I might have more mild lows in the 60's and 70's with a lower A1c. But I actually think that I see more severe lows when I'm trying to get down stubborn highs or rage bolusing after eating a bunch of junk food. As CGMs get more accurate, I think many of us will find that we can reduce our A1c's without necessarily putting ourselves in danger. My G4 is so much better than my previous CGMs at keeping me out of trouble. Good luck with the 530G!

  5. Sounds like both of our appointments were similar. Remember that small changes can yield big results. You are doing great!

  6. Karen I know the frustration first hand. I have fought high blood sugars most of my life and now I am fighting too many lows. I never had heard of an A1c being too low until about two years ago when my Endocrinologist wanted me to get my up higher for safety reasons. I am fighting to a battle to stay under 6.5 which keeps my complications from furthering on. So I am fighting to keep my quality of life but I honestly keep reducing the lows but I am pretty creative in doing so.. I so relate. Hugs hope things improve soon. Duchess send hugs your way too.

  7. Sending big hugs your way!! I've been there, albeit briefly. It is frustrating and I want to encourage you to stay focused and try to overcome this obstacle just as you have the many others that come w diabetes. You can do this!!!

  8. I actually just talked to someone about a week or two ago who also said her A1C was too low. I had never really heard of that before. I know all too well how frustrating A1C results can be since I was just upset by mine last week. Your last paragraph is basically exactly how I felt last week. It's exhausting! Hang in there!


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