hba1c

Where Is The Patient Centred Care?

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When are you seeing your doctor? the Pathologist asked me as I followed her into the demountable Caravan that doubled as the ‘D’ block at my local hospital.

It won’t be until he has the results and calls me in for an appointment I replied. I already signed the release form to receive my results when I came in, but with Australia Post and the Easter long weekend I’ll probably be waiting well over a week.

When did you come in to have your bloodwork done?

Yesterday morning.

Seemingly puzzled at why someone would want to know their own test results, she typed my surname followed by my first name into the computer to check the status of my results.

They haven’t all been done yet. They’re about 80% complete.

Is my hba1c there?

There it is. Don’t tell anyone I told you! She half joked, acting as though she had just committed a serious crime in telling someone their own test results.

Fantastic! I exclaimed, my eyes fixed at where the Pathologist had motioned on the computer display that looked like something out of the 1980s.

Five years ago, I wouldn’t have given a stuff about some stupid test results. I certainly wouldn’t have made a detour on my way home from work because I was that eager to know. I probably would have just let my doctor vaguely lecture me in 2 weeks time, rather than making my own evaluations about the condition I live and breathe 24 hours a day.

I feel like the system isn’t even designed with the patient in mind. Why aren’t we making it easier for patients to engage in their own health matters? Why aren’t we encouraging, and praising self management efforts? Why is lived experience not more highly regarded?

Where is the patient centred care here?

Now you can go home and enjoy your Easter long weekend! the Pathologist replied as I thanked her for her time.

But don’t eat too much chocolate! She exclaimed as I stepped outside into the crisp afternoon, the door slamming shut behind me.

Why I Choose Not to Share My A1C Online

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My latest column for Diabetes Daily is up, and this time I’m respectfully talking about why I’m not a fan of seeing hba1cs in bios and Facebook statuses. 

“A couple of weeks ago, I saw a photo posted into a closed diabetes Facebook group. This photo showed an individual’s pathology report, displaying their latest A1C result. It was an amazing, amazing result. I tip my hat. People were expressing their amazement in the comments. The moderator kindly congratulated the individual, before expressing that everyone is different and that onlookers shouldn’t compare.

I thought that the moderator’s response was impeccable. More so, because it reminded me of why I am reluctant to post my A1c result online.”

You can read the full column over at Diabetes Daily right here.

An Indescribable Feeling

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“Can I get my hba1c done?” I asked my diabetes educator, the minute I walked through the door.

“I’ll go get the kit.”

I waited for what felt like forever, my attention shifting from a wall clock identical to those in my high school, to a weary poster from the 90s shouting reduced risks of cardiovascular diseases for every 1% drop in my hba1c.

As I sat there, exhausted after a full on day and a week of rollercoaster blood sugar levels, I wondered what my hba1c might look like. I hadn’t set the bar very high for myself. I was convinced I wouldn’t be anywhere close to my personal goal. I’d be lucky just to clear the 7% mark, at best.

Even though we say all the time that we are more than just numbers, it’s so freaking hard not to feel defined by one. Every day, I wake up to numbers. I make decisions based on numbers. I over-analyse numbers. I feel frustration over numbers. My long term health is dependent on the numbers. Numbers are the very last thing I see, before I go to bed at night.

I’d be lying if I said that my last hba1c hadn’t been hanging over my head since August. I’ve poured my blood, sweat and tears into my numbers over the past few months. But as my diabetes educator made her return to the room, I was about to learn that all of that effort had paid off.

“You’re joking!” I exclaimed.

“I’m not.”

“I can’t believe it!” I said to myself, leaning back and shooting both my arms up into the air in victory.

The feeling was indescribable.

Not only had I bested my personal goal, but I had clocked in over a point lower than August, and had set a new personal best.

I felt a million miles lighter. I felt like a weight had been lifted off of my shoulders. I felt like I was sitting on top of the world. I felt free.

I couldn’t wipe the grin off my face as I stepped out into the mild, sunny November afternoon. As I made my way down Hospital Avenue and back to my car, I kept repeating my new a1c over and over in my head.

I made a pit stop at San Churros on the way home for a Spanish White Hot Chocolate. A big plate of Connoisseur Belgian Chocolate Ice Cream followed when I arrived home, as I eagerly told my family the news.

I felt proud. I had fought a gruelling battle to regain some form of control over my blood sugar levels in the past year, and I had come out on the other side stronger than ever.

In that moment, I had won.

Working Towards a Lower hba1c

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I am only two weeks away from finding out what my latest hba1c result will be. And I am dying to know.

In August, I learned that my hba1c had gone up after three months on a pump. I was extremely disappointed at the time, but did take solace in the fact that my BGLs are far less variable than they once were. 

I’ve been working hard at taming my blood sugar levels over the past two or so months. I do genuinely feel like I am making progress and taking steps in the right direction. But there are definitely still some tough spots that are taking time to work through. 

Routine has been key to taming my blood sugar levels. Through the week I generally wake up, go to work, have my meals, come home and go to bed at the same time each day. Having that sort of consistency makes it easier to experiment, compare and make adjustments to insulin doses.

Nights have probably been the most consistent. I still wake myself to check once through the night. Sometimes small correction doses are needed, but I am waking up in range almost every morning.

Mornings are probably the smoothest portion of my day, blood sugar wise. It is still extremely tough to obtain consistent results, because I begin work at 7am with varying levels of physical activity from day to day. While breakfast on Monday left my levels smooth sailing, the exact same breakfast (and an identical waking BGL) yesterday sent me a little higher than I’d like. As much as I try not to beat myself up, this is ever so frustrating!

Afternoons have been somewhat tricky to smooth out. I sit down to lunch for an hour at 1pm after a morning of physical activity, which means I need a higher basal rate in action for this hour alone. I go back out to work at 2pm for another hour of physical activity, before finishing at 3pm where I once again need a higher basal rate of insulin. It’s definitely been a loooong game of trial and error, with many curse words thrown towards the sight of upward trend arrows on my FreeStyle Libre. Urgh.

Speaking of FreeStyle Libre, it is a lifesaver. Having easy and unlimited access to glucose monitoring means I have greater insight into what’s happening with my levels. Adjustments are easier to make, and I can better respond to highs and lows. Like this low, that rebounded high, and ended miraculously in a steady line.

 It’s becoming hard to live without it (first world problem, I know…).

Evenings are probably affected a little by my afternoon levels, and I’m confident that they will be easier to manage once my afternoon basal rate is right. My evening meal is also a cooked one, meaning that my carb counts are more estimated and varied than others. 

I am also being super diligent with my eating. I am putting more effort into preparing my meals and snacks through the day. This has definitely resulted in more variety and enthusiasm towards the food in my lunch box (hello ham and eggs on toasted Sourdough), and less of a desire for junk food and unnecessary carbohydrates. I definitely want to expand on this in another post to come. 


I’m also noticing that my total daily dose of insulin is now both lower and more consistent, which can only be a good sign!

Which brings me to now. I am nervous. I have absolutely no idea whether I have done enough to make a dent in my hba1c. I’m trying not to be too unrealistic about my expectations, but I’d be lying if I said I didn’t have high hopes. If my average glucose readings are anything to go by, I’m expecting that I’ll be sitting around half a point lower to where I was in August.

I’m determined to make these last two weeks count. And not because I’m scrambling, like I did back in my diabetes juvie days. I’m watching my FreeStyle Libre reader like a hawk, and making those last minute improvements that will hopefully make all the difference.

I am absolutely dying to find out where my hba1c is sitting right now. Crossing my fingers and toes for November 9…

Highs After Exercise

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It’s amazing how something as simple as a conversation has given me some much needed clarity in recent weeks.

For several weeks, I’ve been giving corrections to stubbornly high glucose levels in the afternoons after I’d finished work. Highs that have made afternoon tea difficult to manage. Highs that have made my dinner time insulin dose less effective and pre-bolusing a complete waste of my time. Highs that have often carried through to bedtime and even resulting in a disappointing waking number.

I didn’t think that there could possibly be anything wrong with my afternoon basal rate, because I knew that it was fine on non working days. I thought maybe I was disconnected in the shower for too long. I thought maybe I was eating too much at lunch. I thought maybe it was time to give up the toasted sandwiches slathered with butter, and cheese oozing out of the edges. Maybe buy those addictive donuts from Woolies less often?

When I recently sat down with my new diabetes educator and my Diasend logbook, she instantly pointed out a recurring pattern of red readings in the afternoons. I knew that afternoons had been a problem area. I can see the afternoon ascent in my Ambulatory Glucose Profile.

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Yet in all these weeks, I had never really stopped and thought twice about it.

It took my educator’s small suggestion of increasing my basal rate in the afternoons for me to finally make sense of all of this. Could these afternoon highs possibly be an after-effect of my physical activity at work all day? Could my body be responding with extra glucose as I put my feet up in the afternoons and breathe a sigh of relief that the day is over? A quick google search confirmed that this indeed, could be a possibility.

The most incredible thing is the positive flow on effect that this small change has produced in the past two weeks. Since increasing my afternoon basal rate from 2-5pm on work days, I find that my BGLs stay in range through the afternoon. My dinner time insulin dose is far more effective, and I no longer receive frustrating highs after an accurately carb counted dinner. Overnights have also been looking much healthier, which will ultimately account for a large chunk of the hba1c result I am chasing.

As my educator reminded me, I can easily be doing this at home as well. I have the tech that is capable of uploading my data to the computer. I have Diasend, the software that compiles all of my data into one easy to read report.


Judging by my Diasend report that is now looking a little less red, I really need to be making the time to do this more often.