I picked up the mail today and opened a letter from my wonderful endo (Dr. Elizabeth Spatola of St. Joseph's in Nashua NH).
Inside it was the latest A1C test and (....drumroll....) my A1c is 6.6%
For me this is the lowest value I've ever had, and I'm more thankful than I can say.
In 2009, I'd like to keep my A1C at around 6.6% for the year. I'm grateful that I can use technology (insulin pump, Dexcom CGM) and rely on many people at TuDiabetes and the entire Diabetes OC (online community) for support and advice. Without all my friends in the d-blogosphere, I think living with diabetes would be a lot harder.
In 2009 may your blood sugars be steady and your diabetes frustrations be few.
For all of us I hope to see some exciting diabetes research development in the next 12 months.
My latest video shows how I used the Diabetech HomeCheck A1c test kit to test my A1c at home.
This is the second time I've used this kit to check my A1c levels. Total cost for the kit is $35.34 including shipping to my home and shipping the test sample back to the Diabetech labs.
In the video I show how to use this simple kit. In the video I mention a form that needs the test date not your birth date. My mistake.
I mailed the test to Diabetech on Tuesday and last night, 3 days later, I got the results back my e-mail (I can also ask for them by postal mail) and they showed my A1c had improved from 7.6% in November to 6.8% in May.
It's a great improvement and I really like that I can do this so easily at home. Total time from ordering the kit to getting the results was 10 days. Pretty good and I really liked the results I got.
Full disclosure: Kevin McMahon, the CEO of Diabetech, is a blogging acquaintance of mine. I've paid in full for both these tests and did this review without being asked to by Kevin. I like the product and admire the work that Diabetech has done to make diabetes management easier.
Recently I put together a table for my endo. It showed how my blood glucose numbers had changed month to month since I started using the Dexcom. I was able to use the Dexcom software to get this information, based on its readings.
I wanted to show it here for a few reasons. (And apologies to anyone who is vision impaired. Blogger does a lousy job with tables, so I had to post a screen snapshot of this.) First of all, my average (Mean column) is improving most months.
My standard deviation (SD column) is also improving. Here standard deviation indicates how tight my control is. It is now more accepted that tight control may mean less complications. If I can keep my standard deviation to about one-third of my average value, then my control is tight. And I'm nearly there.
In the last column I've shown my A1C values. Again there's improvement there, but not as much as the averages would predict. A blood glucose value of 135 mg/dL should give me an A1C of about 6.0%.
This is why I believe the Dexcom readings are lower than my true blood glucose values. And I blame that on the meter it's being calibrated against. Hence my impatience for the new Dexcom model.
It still amazes me how much those of us with diabetes focus on numbers. It's not like we have a choice. We test several times a day and then do some calculation with the numbers to decide how to correct (carbs or insulin). We try to guesstimate the amount of carbs in the food we're eating and how much insulin we need to cover this. We're constantly calculating to try and be substitute pancreases.
I look forward to the day when we're no longer forced to be math geniuses.
Some time ago I mentioned the upcoming release new version of the Dexcom. It will let you calibrate the system without needing that darn cable. You can also use any blood glucose meter. Dexcom calls this 'open coding' and it is meant to be available around March 2008.
There two big advantages to this small change:
You don't need to carry the darn cable anymore
You can calibrate the Dexcom using any blood glucose meter
So why do I think this is such a big deal? Bear with me while I give a long explanation.
Last year I saw my A1C levels improve from April (just after I'd started the Dexcom) to July. But in October my A1C was back over 8.0%. That means my average blood sugar was around 200 mg/dL. However the Dexcom software said my average blood glucose was around 152 mg/dL, equivalent to an A1C of about 6.5%. That's a huge difference. One of the numbers must be wrong...or could they both be right?
Here's how I think the problem arises.
I calibrate my Dexcom with a OneTouch Ultra blood glucose meter. Like most meters, it's accuracy is about plus or minus 20%. (This is what is 'acceptable' according to standards for blood glucose meters.) So if it reports my blood glucose(BG) was 150, it's actually somewhere in the range of 120 to 180 mg/dL.
When I calibrate the Dexcom with it, the Dexcom uses that information when it calculates as my BG values. From experience I know that the Dexcom has a tendency to slightly low ball the numbers. So when it reports my BG at 80 mg/dL, my meter is likely to say it's around 95 (effective range 76 to 114). Result - I'm using a meter with a lowish accuracy to calibrate a continuous glucose monitor that's also got a lowish accuracy.
Perhaps my A1C is high, because I'm carefully using inaccurate systems to keep it within a tight range. It's just the wrong range!
I was given a WaveSense meter last year to review. I liked it a lot, it has a really good design and is easy to use. I even put a YouTube video up that showed the WaveSense in action. The folks had clearly put a lot of thought into the meter. The big thing about WaveSense meters is their accuracy. They certainly conform to ISO standards, all readings are within 20% of the true value. But with these meters, most readings are also within 10% of the real number. So if it reports my BG level as 150, then it's almost definitely between the range 135 to 165 mg/dL. That's way better, to my mind, than the 120 to 180 range for other meters
One thing I noticed whenever I used the WaveSense is that it would frequently give me a higher reading than the other meter I was using at the time. At the time I thought this was strange. Now looking back on it I realize that this is probably because of the WaveSense's better accuracy. The other meter was giving me a slightly lower, but less accurate, reading. Which made me correct with less insulin because I thought my BG was closer to the target that it really was.
When Dexcom allows me to use any meter I want to, I'm not going hesitate. I'll switch right over to the WaveSense meter that I've been using as a backup ever since I got it. That'll give me a third advantage: better A1C results, I hope!
I can't wait.
Update: I got to try out the new Dexcom model for about a week and I've posted about the Dexcom Open Choice with a video and my thoughts on the changes. Good stuff Dexcom.
Note: I currently own shares in Dexcom, I try not to let this ownership influence what I say about the company or its products.
It's been a tough week for me. And I don't really understand why.
Maybe it stems from my A1C at the end of October. In July my A1C had plummeted to 7.0 from 8.4 in April. So I was really looking forward to an even better number.
Running the stats from my Dexcom, I expected at least a small improvement. Especially because I'd been working really hard at improving my diet, adding more exercise. For maybe the first time ever I was starting to think that I had wrestled my diabetes to the ground and won.
Then I got my end of October result.
8.1
What's going on? This number just didn't feel right.
Since then I've had two further A1C tests. One by means of Kevin's excellent A1C-by-mail, HomeCheck A1C, which gave me a result of 7.6 in mid-November. Another at my doctor's office a week later that gave me an A1C of 7.4.
This is one of the great frustrations of diabetes. I'm using a lot of diabetes technology:
And with all of this, I can't seem to get my A1C levels down to a lower level. That's really frustrating.
But I notice that my life seems very flat. Colorless.
Yes, I'm still blogging, and still taking daily photos for the Diabetes365 Project. For the most part I'm taking care of myself.
Recently this has gotten a lot harder. Maybe it's the same kind of issue that Allison is struggling with, but I don't think so.
Perhaps it's some type of low-level depression, which I know often accompanies diabetes. This disease is so wearing, it's a wonder that more of us aren't depressed.
Whatever it is, I just wish it would stop.
If you've got any suggestions, do please let me know.
The Diabetes Technology Blog is focused on using technology to life better with diabetes. I review: blood glucose monitors; continuous glucose monitor; blood sugar meters; diabetes software and living with diabetes.
About Me
Name: Bernard Farrell
Location: Massachusetts, United States
I was born in Ireland and now live in the US.
I have had Type 1 diabetes for over 36 years. I struggle with my blood sugar, the same as most people with diabetes.
I wear a Cozmo 1800 insulin pump and a Dexcom SEVEN CGM to track my blood glucose levels.
I'm blessed by God, and every day brings the possibility of a cure.
