HbA1c, just a number?
Do you ever find yourself paying a little too much attention to a specific number?
Your weight? Your distance covered? Milestones reached? Friends on Facebook?
Or, perhaps, your HbA1c, the “lighthouse” of how you’re doing as a diabetic?
It’s easy to put a lot of weight on a number (pun intended!), because it’s something measurable, something you can follow and have a direct understanding of whether it improves or gets worse.
What’s difficult to understand is that these numbers, none of the ones I mentioned above, matter much.
Your weight technically doesn’t matter much, as long as you feel fit and healthy with it. Neither does the amount of kilometers you ran last week, unless you were in a race… Counting milestones only creates an inner stress and pressure to reach your goals faster, harder, more productively. And, friends on Facebook – are they r e a l l y friends…?
I know. This is crazy cakes.
We’ve been told, time and time again, to set measurable goals, and it’s really hard to find ways to measure improvement without those numbers.
So also when it comes to diabetes care and the HbA1c value.
I’ve been conditioned for 30 years to regard my HbA1c as the shining light of how well I’m doing, so the habit isn’t easy to break. Even when I know I’ve done pretty darn well lately.
I had my a-few-times-a-year appointment with my endocrinologist earlier this week.
Driving there (only takes about 7 minutes, but still), I was super-nervous and kept sending little wishes out for a lower-than-last-time HbA1c reading (which was 6,4%).
I got there, peed in a cup, had some blood taken, weighed in and measured my blood pressure. For someone who has a severe case of “White Coat Syndrome”, which is when you get nervous just seeing, being near or even thinking of a doctors office, the last part always seems a little stupid. And it was this time too, because it was through the roof.
I got into my endo’s office and we chatted a bit about life in general, before we got into the whole diabetes thing.
Once again, I was complimented by her on how well I’m doing. This is still a weird feeling to me, after having basically been a disappointment and being scolded for the other 28 years I’ve met with endocrinologists.
She told me that there probably isn’t much more I can optimize about my care without having a lot more hypos. “Watch me” I thought to myself, as I still think I can, and I will keep trying to optimize and improve until the day I die.
Anyway, to the value that every diabetic has been conditioned to regard as a sign of life or death: my HbA1c was 6,2% this time, or 44 mmol/mol.
This is the lowest I can ever remember having during my 30-year career in and with diabetes. I asked my parents, too, and they can’t remember anything lower either.
The fact that I’ve put so much emphasis on it and then receiving exactly the result I was hoping for made me ecstatic. Happy, euphoric and close to tears of pride. In my opinion, with all right. (And I have yet to celebrate this properly!)
After we had discussed some other topics, and I had received all the supplies I needed from their office (making it feel like Christmas every time I go there!), I got into my car and drove off, full of joy!
I got home, told my husband about the result, he gave ma a huge congratulatory hug, and I was so darn pleased with myself. I posted a rarely-seen-selfie and got on with my day.
Later in the evening it hit me though. I was sad. Despite my excellent HbA1c result. Despite the praise and the congratulations. I felt saddened.
It took me a good few minutes to figure it out, a little EFT tapping and some meditation came in very handy at that point.
I was sad, because that result didn’t mean anything, really.
Fine, it means that I’m reasonably well controlled in my diabetes. It means that I’ve come a long way from where I started a few years ago after a long diabetes burn out, giving me double figure HbA1c’s. And it gives me a little hope for the future.
But it also means that I’m not really awarded in anyway for it (unless I buy myself something pretty, or have a glass of champagne to celebrate). It doesn’t give me a break from diabetes, not even for a minute. It doesn’t stop the poking, prodding and always having to be on alert. It doesn’t mean I can live carefree and forget about everything.
It just means that I’m alright and that my doctor is proud of me. And that I’m technically “pre-diabetic” according to my HbA1c.
Don’t get me wrong.
I love the fact hat I’ve found my own way and am finally in the position where I feel like I have even the faintest of clues about this whole diabetes thing.
I love the feeling of not being scolded by my dream health care team. And I love that I can say that I’ve reached a new record in my life.
But I don’t think it’s the best idea to put as much of a value as I do on this one value. Especially as there are so many other factors that determine how well I’m doing and/or how healthy I am.
What about you – do you also put too much emphasis on one single number? Perhaps it’s your weight? How far you’ve run this week? Or maybe you’re like me and put (too) much focus on your HbA1c?
This is such perfect timing and I am thankful that you posted this experience with the good old friend HbA1c.
I am type 1 since I am 4 years old, which makes it by now 23 years, a long time. Sometimes it feels even longer.
Within the last 3 years I could not and did not pay as much attention to my diabetes because I suffered (maybe still…) a major eating disorder. Ha and there they are again: number! Not only did I learn how to work on controlling my HbA1c but “all the sudden” I also wanted to control all the number that stand in connection to eating, food and my body. It was a hell of a ride I went from 72kg (being 178cm) to 49-48kg within 10 month. It was exhausting, even more so because I am diabetic. I went through days with eating close to nothing and that is hard for any body, especially for one with type 1.
I am in rehab no for a bit over a year. But numbers and controlling are still big and sometimes, just as you said it, these HbA1c numbers make all the difference, exactly because it can feel as if they don’t make any difference at all. It is frustrating for me to see, how much effort I put into having a stable and good blood sugar and still not being close to a good HbA1c. My Doc is very kind and good about all this, she explained that it takes time for things to “normalize” again. And there comes the twist: it is never normal, it is never carefree, it is never just being, just eating, just traveling…just whatever. It is always there! And I feel you when you say, that this can be tiering, at least it is for me.
But I know that I am not going to get rid of it, so on the good days I see it as something very natural, like my brown hair, simply belongs to me! And I can treat it like a old friend… But even more importantly, I also let the steam of at the dark days.
Thanks for giving me the chance to see, that it is normal to be angry and it does not mean that I am losing control or being a bad diabetic… it is just part of the deal!
Your comment gave me goosebumps! And your story is incredibly touching, thank you so much for sharing it with me. <3
You're very right: "it is never normal, it is never carefree, it is never just being, just eating, just traveling…just whatever. It is always there!" - I can very much relate to this and I think many others can too!
Keep fighting the good fight, Rebecca, you're doing an amazing job and you should really be proud of yourself. Feel free to email me (email@example.com) anytime if you need a little support. You are a superhero.
Big, big hugs to you.