Type 1 Diabetes

Be Afraid…

August 31, 2010

Oh no.

We all know it’s coming at some point. Twice a year, in fact. You try to dismiss it; ignore it and pretend it will never ever happen. But it allllllways arrives sooner or later – plonks itself on the doormat oh-so-innocently, creeping up on you when you least expect it, late enough to think you might have got away with it.

The dreaded HbA1c appointment.

I don’t know what it is about clinic. You know you’re going to have a check up every six months, yet no matter how many years go by, it always seems to come around too quickly. And as good as you know your blood sugars have been (hopefully), the prospect just fills you with dread. One flimsy piece of paper… “An appointment has been made for you to attend the Diabetes Clinic…” VOM.

Now for the non-diabetics amongst us, a HbA1c is like the end of year exam. It’s the assessment above all assessments of your status as a good/bad diabetic. I know, I know, there’s no such thing… but you don’t want to face that Demon Headmaster-esque stare that occurs when your blood is taken and the nurse/doctor in question pulls “that” face.

Must try harder.

So, the HbA1c is the 2/3 month average of your blood sugar levels. We test our blood sugar levels multiple times a day, so this is nothing new. The aim is to keep it within that glorious range of between 4 and 9 mmol/L. So the HbA1c is just the average of this over a couple of months. I’ve no idea what that weird letter/combination actually stands for, and I have no desire to find out. There is a target, and if the target isn’t met, you know you’re probably about to face *that* look – if not from the nurse, then more than likely from yourself. Seriously, I think a good proportion of the issues diabetics face stem from the pressure we put on ourselves to be perfect at this bloody impossible disease. But there is something about a HbA1c that, the closer it looms, the easier it suddenly becomes possible to say no to that piece of cake.

You’d be big fat COR-RECT (game show stylee) if you’re suddenly thinking “Hang on a minute missy, that doesn’t really appear to make any sense.” It doesn’t. If you only behave for the 2/3 months ahead of your bi-annual test, you’re only being good a maximum of 6 months of the year. And I reckon behaving 50 per cent of the time isn’t enough to bypass all these glorious repercussions we’re trying to knock on the head. So what’s the problem? Just behave all the time, goddammit. Sorry folks, game over. Try as you might, it ain’t possible, and it ain’t realistic. You can be good as often as life will allow you, but life has a very turbulent relationship with diabetes. They just aren’t naturally suited. And so when the HbA1c rears its intimidating head, it’s ok to be a little bit nervous, because at no other time is there a result so stark, so quantitative and as such the be all and end all of your status as a diabetic. Dramatic much? We test our blood sugars every day, for crying aaatt laaaaaud. And actually, the HbA1c result it just another blood sugar test. So what’s to worry about?

I think the way I (and many others out there) view these appointments is a reflection on diabetes education and teachings, or certainly my experience of them. OHHH, CONTROVERSIAL. But why otherwise should I feel apprehensive and nervous about something that’s totally in my control? The diabetes specialist that I had when I was a child is absolutely not to blame for this. He would never ever belittle or patronise me about my behaviour or my results. Probably because before I got introduced to boys and alcohol I was only interested in running about and climbing trees, activities which happen to be conducive to amazing HbA1c results. But theeeeen… I went to uni and I was pretty shit at being a diabetic. Granted. But the doctor I had there just did not have a way with words. To the point that every time I’m now told my blood pressure is about to be taken I have a little palpitation because of the fear he’s instilled in me about keeping it low. That’s surely not right? Then, that also contradicts my earlier musings about us needing to have the seriousness of the consequences of prolonged poor control all laid out on the table as early as possible. Confused? ME TOO.

I can appreciate that there may never be a perfect way to instruct someone on how exactly to control their diabetes. It’s about learning it all on your own, because you eventually realise it’s for your own good and if you don’t, your day-to-day life seriously suffers. When it comes down to it, you have to learn these lessons sans any parents, nurses, specialists, understanding partners. The Hard Way. But hopefully not the Too Late Way. No-one tells you that though while you’re wading through the fog of a disease that you’d never heard of before the day you were diagnosed. Hence the need for this very site. Howdy.

So really, if my HbA1c is higher than one would really like it to be, all that will hopefully happen is that we’ll just keep on trucking until we see that fully understand that although we’ll never be perfect and therefore shouldn’t put ourselves under ridiculous amounts of pressure that lead to guilt and god knows what else, good control is actually on whole fully in our grasp, as a result of the decisions we make every single day – every single hour. If we do this as often as possible without sacrificing the fun stuff, the HbA1c will reflect this because it is precisely that – an average that chops off the reading of 17.9 that we just can’t understand, and may quietly disregard the odd occasion when you didn’t quite take enough insulin to cover the chocolate cake. Which we’ll now pass on. At least until after we’ve been to clinic.

Gif

8 Comments

  • Reply Type One September 1, 2010 at 3:53 pm

    I’m a type 1 diabetic and can’t disagree more with this article.

    I work very hard at eating only 3 times a day, no snacking, carb counting and no drink.

    My control is excellent and my hba1c has only once been higher than 7 ( first 6 months after diagnosis )

    The real problem is most diabetics don’t accept that you are different. Whatever you did before or your friends do – you HAVE to do differently.

    Or you can just be lazy, sneak snacks and dread the appt

    • Reply missjengrieves September 1, 2010 at 4:14 pm

      Thanks for your comments, but I think you’ve misunderstood me. The whole point of me writing the blog is because I’m striving for control like yours. But it’s hard and it takes a lot of effort, and no matter how good I’m being with my sugars and everything else, there is a slight feeling of dread about going for HbA1c’s. Many diabetics don’t understand the seriousness of the condition and that’s why I’m writing about it. Most of what I say is very tongue in cheek and needs to be taken as such.
      I’m sorry you disagree with the article but congratulations on your good control.

      • Reply Chris B September 2, 2010 at 9:54 am

        Man, wish I was able to control my hba1c as well as some. I think my problem is I don’t fear the appointment.

        I met up with Ben and Jerry last night, they make me smile. I think the answer is a restraining order.

        Either that or stapling my tongue to my cheek so eating is less enjoyable…

        Great blog.

        • Reply missjengrieves September 6, 2010 at 10:10 pm

          Hey Chris, sorry for being awol. I’m back for good, Take That stylee. Love your comments as always. Please don’t resort to staple-based measures to resist B&J. They’ve helped me through some very bad times! Hope you’re well x

  • Reply chris king September 1, 2010 at 5:06 pm

    A very good blog, this is exactly what l feel like every 6 months, I try really hard several weeks before and after my appointment, then life kicks in and I start to lapse in to my bad ways, a cake here and a cake there, it’s only a treat, surely it cannot hurt but I know I am heading towards trouble.

    • Reply missjengrieves September 6, 2010 at 10:09 pm

      That’s just life though isn’t it? We can’t be perfect all of the time, but if we’re trying then I think we’re half way there. Intentions versus cake, hmm! Sometimes cake just wins nom nom nom. Thank you for your comments!

  • Reply Nicola Sinclair September 2, 2010 at 10:28 am

    My 5yo daughter is T1D, diagnosed at 2, and I hate the HbA1c test. I am usually shocked when it has been a good result because I don’t think we have been managing that well or when I think we have been getting reasonable readings the HbA1c comes back at 9+!!!!
    But I think what really upsets me is that a lot of people say you can lead a normal life…. and then all you keep being told is to feed her the same quantities of food every day, at the same times every day etc… well what’s normal about that for a small child??? So I think having a child with diabetes is very difficult. I just wish it was me that had been diagnosed with it because then it wouldn’t matter if the HbA1c comes back with a high result as it would be my own fault but when it comes back as high for my daughter I not only have our diabetes team all giving me ‘the look’ but I beat myself up big time for what I am doing to my daughter!!!

    • Reply missjengrieves September 6, 2010 at 10:13 pm

      Aw I’m sorry you feel so guilty. I think that’s surely natural as a parent? Not that I’m assuming to know how it feels. I do remember my parents confused faces, but I was eight so we were in it together. It’s just all such a minefield. I really wouldn’t beat yourself up, you’re only trying to do the best for her in a very alien world! I’m sure she’ll thank you for it when she’s old enough to understand it all. Thanks for your comments I hope the next HbA1c is fabulous!

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