Monday, April 19, 2010

The 6.5 A1C

I was sitting on an examining table at Dr. W’s office, my endocrinologist, a couple of weeks ago waiting for him to get off the phone when I asked the nurse if she could make a copy for me of my quarterly lab test results, the results that would tell me my latest A1C - the test that gauges how well diabetics manage the disease. How well I’m managing my diabetes.

I was amazed at myself because I have been asking for those lab test copies the minute I walk in the office door for decades, and that day, it completely slipped my mind until I was sitting on the table waiting for Dr. W to tell me what latest thing I needed to change or do. That’s usually what happens at these doctor’s appointments.

I have been somewhat obsessed with the A1C number for the past decade or so. Why? I hate failing in general, but that one in particular is one that I loathe failing. The goal is a 6.5, and I had never gotten there before. I had been holding steady at 6.7 for five or six years, not quite making the 6.5, and before that I was holding at a 7 for about two or three years, and before that an 8.4 for I don’t know how long, and before that, I have no idea. For the past decade or so that I’ve been conscious of my A1C and actually trying to make it better, I have felt frustrated and less than adequate at the one job I work at the hardest - 24 hours a day, 7 days a week.

And then as I sat there in the doctor’s office, I realized that I hadn’t thought about the dream A1C in a long time, the 6.5. For the past three months, I had still been exercising, meditating, eating healthy, and monitoring my sugars in relation to all of these things, but I hadn’t really thought about the goal itself. I realized that I had let it go and began simply plodding along living my life in a balanced and healthy way.

The nurse returned, Dr. W still on the phone solving a crisis with another patient, and she handed me the pages. I thanked her and began scanning. Cholesterol – fantastic! Protein in urine – None to be found (protein spillage determines possible kidney disease which I had when I was 21 years old)!

But I was really searching for the A1C. I had to see the numbers, the results of all my hard work – the monitoring, pricking, bleeding, squeezing, tracking, evaluating, assessing, meal planning, weighing, exercising, and sugar inducing during the lows, and so on.

And as I continued scanning, I found it. There it was: A1C – 6.5. I reached my goal! Or at least the goal that endocrinologists have set for me since I started this diabetic journey in 1974. And it only took over 35 years to get here! But I’m here now!

The 6.5 A1C journey has been a long one. The first A1C I remember was an 8.4 which I learned about somewhere in the mid ‘90s. I guess that was the first A1C that I was half conscious for, which I assume was the case since I kept the document on file and still have it today. The next lab test document that I have in my file was taken a few months later, and the A1C read 8.2.

So what changed? How did my A1C path shift and start trending toward healthy levels?

That’s a big question. It’s a lot of things: patience, persistence, doctor-patient relationships, science, tracking, willingness to change routine, education, eating healthy, exercise.

It started with Dr. P back in the 8.4 days. Dr. P was considered an aggressive doctor, but quite frankly, she was exactly what I needed. Dr. P was incredibly persistent with me on monitoring and tracking my blood sugars. She also sent me to a nutritionist. I learned how to better plan my meals and eat healthy, well-balanced food. I started a regular exercise program and found myself becoming addicted to it! I read Diabetes Forecast monthly to learn about the latest information and stay informed. I had also started seeking support and talking about my diabetes for the first time in my life.

Types of insulins were advancing back then too, and Dr. P kept up to date. She switched me from pigs’ insulin to synthetic Humalog and Lantus, all injected through needles and back then considered the latest and greatest in insulin because they resemble human insulin more closely. I had made my way down to a 7.2.

I switched to the pump four years ago, after the Dr. P years but before Dr. W, and after reaching a 6.8. The pump has been the greatest blessing for diabetics as it attempts to mimic a fully-functioning, insulin producing pancreas. I had to basal test for a long time – which involves fasting and testing sugars every hour on the hour – until the docs found the right patterns for me. But I stayed persistent and tried to be patient (not always succeeding at that part), and eventually I found Dr. W who really understood how to set a basal pattern correctly. At that point, I had made my way down to a 6.7.

The big “ah ha” was when he told me that my basal patterns are fine, I need to focus on how much insulin to administer for different kinds of food. I had already learned carb counting, which is the typical lesson we diabetics learn when we go on the pump. We calculate how to bolus – or inject – insulin based on how many carbohydrates we are eating. But Dr. W claims that there’s more to it than that. Dr. W’s theory is that each food reacts differently in every person’s body, and so it’s up to us to look at each food and test how our bodies react to it. Then figure out the right bolus.

The more you are aware of your sugars in relation to the meals you eat, the dosages of insulin you administer, and the amount of physical activity you perform, the better your sugars will be. I find this all to be a royal pain in the neck. I hate tracking and testing it. I mean, I really hate it.

Dr. W would love to set up a study on this topic. I think that people first have to want to do it, to care that much about their health and bodies, to do all of the work involved in diabetes management.

And where does that desire come from? It comes from within.

Besides all of the stuff that diabetes doctors and educators have been talking about for years, all of those details I only glossed over above, there’s also the human side. Being a healthy diabetic requires living with the disease in an emotionally healthy way: Knowing who you are and accepting yourself fully. Listening and having compassion for yourself and others. And living your life’s passions to the fullest. It’s all connected.

Your state of mind - and dare I say connection to spirit - affects your state of body.

Dr. W got off the phone and started telling me the story behind the emergency call, apologizing for taking so long, “This guy just had his leg amputated. He’s on dialysis. I wish I had the ability to teach people how to live with the disease beyond what I can do in this office,” is more or less what he said.

He picked up my lab tests. “Look at these numbers,” Dr. W was scanning too, “We’ve been seeing each other for the past year, and I’ve seen you come a long way. 6.5 A1C. You’ve lost 5 pounds which is very good for a person at your weight. Perfect cholesterol. Not an ounce of protein. You’ve basically cured yourself of kidney disease.”

I left Dr. W's that day realizing that I’m in the best health I’ve ever been in my life, and I felt very proud. And I realized that the journey changed for the better the moment I became conscious. The moment I became conscious of self-love.