Sarah Howard
Sarah Howard (nee Tackett) has dedicated her career to supporting the T1D community ever since she was diagnosed with T1D while in college in May 2013. Since then, she has worked for various diabetes organizations, focusing on research, advocacy, and community-building efforts for people with T1D and their loved ones. Sarah is currently the Senior Manager of Marketing at T1D Exchange.
Sarah and her husband live in NYC with their cat Gracie. In her spare time, she enjoys doing comedy, taking dance classes, visiting art museums, and exploring different neighborhoods in NYC.
No, but at my last appt. my endo said my 6.1 was low enough. I told him I disagreed.
I had a nurse at the endocrinologist office tell me 5.8 was too low. The doctor told me I was doing a great job at the same appointment. I believe it was because the CGM verified my good A1C wasn’t the result of a lot of lows but instead steady, controlled numbers.
I’ve been told I drive my pump like I have a “lead foot”. Told to ease up on my corrections.
My T1D husband was told to run higher as his mobility required a walker, and he was one who preferred an A1C on the ragged edge of LOW. Older adults with this disease have to make changes as they grow elderly. For one thing you don’t need as much insulin and the other topic is safety concerns of low blood sugars. We also learned that Beta Blockers cause extreme lows called “masked lows”. Many cardiologists don’t know that fact and looked at me like “who are you”?
When I developed heart disease, my endo and cardiologist told me that they did not want me running in the low 6’s due to the higher risk of hypos with heart disease. Since then, I have come up to the mid 6’s with < 2% lows on CGM. I am fine with this.
Not in so many words, but she did say 5.8 might mean I was having a lot of lows. She seemed like she thought it was too low. Usually, I am 6.1 to 6.3 and she seems happy with that. Personally, I couldn’t believe it was 5.8. I try to keep track in my head and that three months seemed like I had a lot of highs.
I was told that 5.9 was too low for a person of my age (73)
When I recorded an A1c of 5.4% my endo said, “That’s lower than mine!” I responded saying, “You might want to see a doctor about that.” Ultimately, my goal is to get down to 4.8%, which is what a non-diabetic A1c looks like. I doubt I’ll ever get there b/c I’m just not THAT disciplined, so I’m happy with anything below 6% these days.
With hard work and a lot of insulin O got my A1c down to 5.3 while pregnant. My maternal fetal specialist was happy as she was monitoring me closely knew I wasn’t having crazy lows. But as soon as I had my son and returned to my regular Endo she balked at my 5.3 and said it needed to be higher. I just brushed her off. It went back into the 6s postpartum anyway.
Yes, with very few lows and no critical lows. I don’t think most endocrinologists are used to seeing people who take their diabetes seriously.
I take my diabetes management very seriously but the lowest A1c I’ve had since diagnosis was 6.3. However I am always under 7 so am happy with that. I try not to obsess over numbers but with T1D that’s hard!
I’ve been told on numerous occasions to bring my levels up. Over the last 5 years my results hover between 5.6 to 6.4 and as my endocrinologist suspects that I’m experiencing too many lows. In actual fact I do have the odd low but my levels seem to be much more streamlined due to my pump and CGM.
In early 2012 before I had a Dexcom I finally had decided to take control of my diabetes and actually pay attention to what I was doing, eating, and how much insulin I was taking and keeping impeccable notes of my blood sugars. I went for my semi-annual endo appointment and my A1C came back as 6.1 after having hovered in the mid 7’s for decades. My endo – an old senior endo at the Joslin ordered me to do a sensor study with the horrible Medtronic iPro device because he thought there was no chance of me having a 6.1 without significant hypos. The study data was not particularly useful, but there weren’t any hypos so he just left me alone. Now with Dexcom data to back me up, my new endo is fine with whatever number that shows up. She and I both prefer time in range as an indicator of blood sugar management.
I wish! Haha
This is kind of an artifact of the pre-CGM era. A1C is an AVERAGE, not a mean, and the theory was that you could only get below ~6.5 by having hypos dragging down the number. Especially true back in the bad old R/NPH days. So yeah, when I’d get below 6.5 I’d get yelled at. 6.5-7.0 was acceptable. With CGM you have better information to control what you’re doing and a 24/7 curve that shows how many lows you’re actually having. So it’s less of a thing now, though there are still old-school medicos out there.
for decades I had tight D mgt. After moving to a new city and a new health plan and thus new Endo’s I was told “…it is impossible for someone like you to have such good labs…” (and I am quoting here – I will never forget that offensive statement). At that time my A1C was 5.7. After promising to bring my Mensa card to the next appt, I whipped out my reports from my Dexcom. That HMO plan didn’t cover Dexcom – the look on that Endork’s face was worth paying out of pocket. Anyway, I asked to be assigned to someone else.
I’ve been told it was to high. It was. I am of the view that each person is different, and so long as they have data to show they aren’t having to many hypos, and working with their medical team they are fine. I’m starting to see in online support groups shaming people for a1c’s being to low or to high. If it’s in the range that you and your medical team decide is good for you then go for it, but don’t make other feel like poop because they may shoot for a higher or lower number.
Told I shouldn’t be any lower than 6.4 because of it being an average, it must mean I have a lot of lows. Not on CGM but after seeing my labs and telling me “normal” people would kill for my reports, they have left me alone. I do have lows but we are working on those.
Getting ready to switch from Metronic guardian sensor to decks calm. Hoping my A-1 C will move back to the low sixes
DexCom!!
The issue with having a low A1c indicating too many lows is potentially valid in those with T1D BUT 1) not with use of modern CGM, which picks up lows 2) does not apply to those on hybrid closed loop pump 3) does not apply if the A1c underestimates average blood glucose, which is common in the population and would be consistent in the same person one time to the next 4) needs to be individualized, as with all rec’s in those w T1D—– It is true that reducing mean blood glucose below a certain level (in the 135 range which correlates with an A1c of 6.5 in the population) provides little additional benefit in reducing long term complications but is often associated with an increase in time spent below range, that is , hypoglycemia, which is not a normal state. That (more hypo’s) may do more harm than good even in worsening complications- —————and can be dangerous in the short term for obvious reasons.
When I first went on a pump (before CGM was readily available to users), I had one A1c of 4.6 and my endo said I had to wear a CGM for a week so he could show me how dangerous it was to be that low. The CGM he gave me didn’t show me any readings, but the readings were available when I returned to the endo (and I was doing ~20 finger sticks/day). During that entire week, the CGM said my BG was always between 70 and 110 (i.e., no lows and no highs). He never told me I shouldn’t have a low A1c again!
I have never been told it is too low even though it is often in or close to the normal blood sugar range. Throughout my 59+ years living with diabetes I have been blessed with skilled Endos and Diabetes Educators. Rather what they do ask me is if I have had any extremes of high of low blood sugars that have been difficult for me and have I needed assistance from others.
I haven’t been told too low, but said I didn’t need to try so hard. last was 5.1.