Friday, June 22, 2012

Chasing 6.9 (An A1c Story)

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Last week I went to my endocrinologist, full of hope. I had been managing myself better than ever over the past few months; more numbers in range than ever before, as far as I could tell. Due to some developments in my family, I had been eating lower-carb, and I had joined a gym and was trying to run at least three days a week. When I got to the office and the nurse called up my profile, I had to sneak a look at the A1c result as soon as possible.

It was my lowest ever. 7.2. And my first reaction was the prickling of tears behind my eyes.

Tears of disappointment.

I know what you're thinking. The lowest A1c result since she started taking these tests 15 years ago, and she's disappointed?

The problem is, I had just spent the past week congratulating myself on a number that didn't exist. Even with my constant mental reminders not to do this if I wanted to avoid disappointment, my brain had anticipated finally breaking the 7 barrier. I was prematurely convinced that 6.9 was my fate, as Dr. Zoidberg would say, why not? After all, I had done so much since I had last been in that intimidating office.

There was a post on another DBlog (I can't remember which, I'm sorry!) that talked about the danger of congratulating ourselves too much for good numbers, because it tends to lead to beating ourselves up for bad numbers.

Diabetes is a tyranny of numbers, both in the sheer amount of numbers diabetics deal with on a daily basis, and the weight of meaning those numbers hold. We tell ourselves not to internalize these numbers, but how do you not internalize numbers when they represent what's happening internally? There are carb count numbers, blood glucose numbers, A1c numbers, cholesterol numbers, blood pressure numbers, thyroid numbers (everything was good with all of these at my visit, which was amazing). There's also weight. This is another post entirely, but insulin promotes weight gain, particularly when low blood glucose results occur and eating everything in sight seems like the only option.  Of late, many of my hypos are linked to exercise, so a positive thing for weight that requires effort is often negated. Tighter control of one number (BG) leads to less control of another (lbs).  At this appointment, I found that, not only had I kept my A1c lower than ever, but I hadn't gained weight; I had LOST six pounds.

But I want to lose 40, even though I realize it's probably not realistic for me to go back to the weight I was at before I went on insulin, when nothing I ate was being absorbed by my body. (That's a subject for a whole 'nother post.)  So I was still disappointed. It wasn't enough.

I confessed my disappointment to my endo. "I was really hoping for a 6.9 since I've been trying so hard," I said.

"To be honest, I think you're fine right where you are. What's the real difference between 7.2 and 6.9? Practically, in terms of complications? Not much. What would 6.9 mean? Maybe more lows. I think I'd be thrilled if you stayed in this range every time."

That's right, folks. My endo, who I have had, shall we say, a tempestuous relationship with since Day One (another number), who greeted my numbers with dismay and irritation for years (because they were terrible), was telling me she was thrilled and proud and that I shouldn't be so hard on myself. It was so strange I almost laughed. "I've been the problem all these years, not her," I thought. Again, I had to tell myself that neither of us are the "problem," diabetes is. (Again, a subject for its own post.)

Maybe it's good that I'm disappointed by my best, because it represents a new mindset going forward with this condition. Maybe it's not, because perfection is impossible, and leads to burnout. What would I be "happy" with, after 6.9? 6.5? 6? We look for "magic" numbers in A1c, and in weight, but often even when they're reached, we're still not happy, because we secretly want more...well, less. Lower is never enough. What is it? Do we want to disappear?

As diabetics, we're told to "look at the big picture." Maybe that one result doesn't mean anything. Maybe that A1c doesn't mean anything. On one hand, this is helpful thinking, promoting neither complacency nor depression. One success or failure doesn't mean much, because it's one over a lifetime. But sometimes just looking at the big picture means that it's hard to be happy with the little victories, which is depressing in its own way. When you're looking at the rest of your life, with constant maintenance, what is success? In a way, you can't tell until it's over.

How do we manage to do both? How do we both reward ourselves for that small amount of weight loss, that small amount of extra control, while still remaining in the mindset that we still have to keep going? How do we simultaneously exist as Good Cop and Bad Cop regarding our own performance? I don't think that's solely a diabetic question; I think that's a human one.

It's good to celebrate moments; after all, as Stephen Sondheim observed, life is made of them. (Of course, if I'm turning to musical theatre, I could also tell myself to "kiss today goodbye and point me toward tomorrow.") Maybe I should celebrate 7.2. It's a nice number, without any of the hilarious sexual connotations (that I know of).  Maybe I should celebrate that a <7 number is even within the realm of possibility/expectation. Maybe I feel like I need permission to celebrate. In a big way, I thank my endo for telling me I could.

What do you think about celebrating the small stuff? Yay or nay? Good, or limiting?



  1. I say celebrate (or maybe congratulate is a better word)... just in a little way, give yourself a pat on the back sort of thing.
    Hee, hee, I just was at the Dr. last week and guess what, my A1C was also 7.2. I've been working hard, feel like i'm doing so much better than I have in the past but my number isn't hugely different than the last (7.6) so, i'm with your Dr. on scaling the significance of 7.2. I'd LOVE to see a number under 7, never been there in 34 years but... i'd be so much happier if I just FELT like 6.9, no matter what the number really is. If you feel like 6.9, then I think you should be celebrating like 6.9!

    My Dr. was pretty pleased with 7.2.. and when I walked away I felt decent. I didn't jump for joy or anything, just felt like I should be proud of myself. Hope you are standing proud too!

    So... i'll pass along to you what I had hoped i'd get from someone:
    a hug, and a "you are doing good" pat on the back.
    If you want to have a cupcake to go with it, that's up to you :)

    1. Thanks for the comment and the pat on the back! We all need one sometimes, and your comment made my day.

  2. Above all, I see one spot which you should congratulate yourself for no matter what numbers show themselves.

    "I had been managing myself better than ever over the past few months."

    You should celebrate your hard work and determination. You should be proud of yourself for doing the best for yourself. To me, this is worth more than any number.

    1. Thanks! It's so easy to get hung up on numbers when the effort behind them is what's so important. Thanks for reading and commenting. :)