Ask Dana: how do I improve my diabetes management?

Ask Dana: What should my goals be and how do I improve my diabetes management?

QUESTION:

I have had diabetes for many years but recently have added an extra layer of focus to improving my health and diabetes management.  After so many years, I wonder how I know if my diabetes management is getting better and if I’m doing what I am supposed to do.  I don’t think has ever told me what my goals are and how I should measure improvements to my health.

– Mary McMillian
Boston, Massachusetts

ANSWER:

Dear Mary,

This is a great question! It is always a good idea to know your goals! 

For many years, most doctors and people living with diabetes have focused on their HbA1c level as their “go to” lab level to determine diabetes success.  The American Association of Clinical Endocrinology (AACE) publishes guidelines for diabetes management.  Included in these guidelines is the goal of therapy for an HbA1c.  The AACE goal for diabetes management is an HbA1c of 6.5% or lower for most people living with diabetes unless they are at greater risk for hypoglycemia events.  However, in the case of HbA1c, lower is not always better.  Studies have shown that there is no added health benefits of HbA1c’s lower than 5.8%.  And the reduction in most long-term complication risks tapers off significantly with A1c’s below 6.5%. Keep this in mind as you focus on your health goals.

HbA1c is one way to gauge your diabetes management; but, it is not the only benchmark of success.  I would also say that it Is not the best benchmark as it is a three month average – not real-time data.  With the widespread use of continuous glucose monitors (CGMs) we now have another metric called “Time In Range” (TIR) to determine how often one’s blood glucose numbers are within the recommended range. This range is between 70mg/dl (3.9 mmol/L) and 180 mg/dl (10 mmol/L).  For people living with diabetes, the recommended goal of TIR is above 70% out of 100%.  Additionally, AACE guidelines recommend blood sugars under 70 mg/dl (3.8 mmol/L) less than 4% of the time with less than 1% under 54mg/dl (3 mmol/L).  Keeping realistic goals in mind is very helpful as you watch your CGM data.  It is unrealistic to expect blood sugars to be 100% time in range.  It is also worth noting how often and what percentage of the time blood sugars are above or below the recommended TIR.

These numbers and percentages may or may not be new to you.  However, with the use of CGMs comes an onslaught of data and numbers.  It is easy to feel that you are not as successful as you want to be.  Who doesn’t want to see their glucose numbers 100% time in range?  It is easy to become discouraged with the comparisons from social media accounts and casual comments made from doctors and health care providers.

Diabetes management is not only about the numbers.  Diabetes is not about being perfect. While you are focused on your diabetes management, aim to find success in activities outside of the doctor’s office.  It is very helpful to sit back and evaluate your personal goals and what success might look like at home.

For example, have you recently noticed a more positive relationship with your diabetes management?  Maybe you are taking time to do more exercise or physical activity? Are you sleeping better and maybe feeling more energetic?  Perhaps you started to enjoy a new healthy recipe? You may, even, have started to follow some new health-focused websites? All of these are great additions to your diabetes management.

Remember, success comes in many forms.  Diabetes is not about being perfect and you are not defined by numbers.  Diabetes management needs to be healthy and successful for YOU.  Along your journey, choose ways to achieve success for you as an individual in whatever form that takes.  If you need help, ask for it.  All of us at IDS are here to help guide you toward your own personal success. Give us a call anytime!