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Discussion Starter · #1 ·
I thought last year a good A1C was 7 or less.

Now I see it is 4.8 to 5.9.

I also know that as of the Diabetes conference as COVID was beginning, the discussion was that A1C was not a good tool to describe success in treating Diabetes. Damage from Diabetes occurring because of the radical changes in Blood Sugar. That is Blood Sugar going up and down like a roller coaster causes damage. While a stable A1C of 7.1 would not cause damage.

Still, I am curious. A1C less than six seems a bit, of an over reach.

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A doctor friend of mine believes an A1c of 7 is good, particularly for T1s and people with hypoglycemic unawareness, since it gives them a bigger cushion in case of a low. An A1c under 7 also seems to be the number that -- OH! 馃榾 -- certain diabetes medications seem to shoot for as a goal. I think tighter control could make a lower A1c achievable, but I don't necessarily follow every professional association guideline.

4.8 to 5.9 is pretty much the higher end of the non-diabetic A1c range, at which diabetic complications are much less likely to occur. I've seen a few studies that conclude, though, that the body's balance of glucose/insulin/glucagon is better without big spikes or dips which cause the body's glucose-management system to react quickly -- sometimes overreact.

From that perspective, it would be better to have a 7.1 that was achieved with just short spikes into BG readings of, say, 200 than it would be to have a 6.1 achieved through big spikes and then lows because the glucose/insulin balance was poorly managed. But I would say that leaves A1c as an important indicator of average BG, understanding that it -- like all averages -- does not illustrate how it got to that number. Median or mode would be a better measure but I don't know if there's a test that could determine that. That's what regular testing (or a CGM) would do.

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A stable A1c of 7% is akin to an average BG of 154 mg/dL (8.56 mmol/L). At one time the AACE (American Association of Clinical Endocrinologist) were recommending to stay below 140 mg/dL (7.8 mmol L, which equates to an A1c of 6.5%.

Its just my opinion, but ai think a Type 1 with a 7.0 A1c is better off than a Type 2 with a 7.0 A1c. Assuming they had the same swings, the type 2 is dealing with a much more active balancing act. Too much circulating insulin is also bad for a body, not just glucose.

Blood Sugar 101 has changed a little over the years but still lists studies of BG levels causing organ damage that influence the AACE recommendations. They wanted to never go over 140 but the ADA was happy up to 180. The ADA is very slowly starting to see the light the AACE was shining a few years back.

The studies you will read below, some of which are not cited in the AACE guidelines, make a cogent case that post-meal blood sugars of 140 mg/dl (7.8 mmol/L) and higher and fasting blood sugars over 100 mg/dl (5.6 mmol/L) when found in association with those higher than normal post-meal blood sugars, cause both permanent organ damage and the worsening of diabetes. Some of this data also suggests that maintaining an A1c of 5.7% to 6% is much safer for people with diabetes who wish to avoid developing diabetic complications.

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The problem with an A1C of 7.0 is that you probably have a lot of highs in order to achieve that 7.0. Current studies show that spikes over 120 are doing cell damage, so my goal is to never go over 120. Ever. I am off all meds and maintain a 4.7 A1C. It takes commitment, but it's worth it, I believe.
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