A1C !!! It's that time of the year again ...

 We had our quarterly Endo follow up appointment last week.  This blog is going to be more about the run up to the appointment than the appointment itself.  Anyone who has diabetes knows that one of the main points of discussion in these appointments is the a1c result.  The a1c is the number that would estimate the average blood glucose of the past three months.  The a1c tests are the pretty much only point of reference for people without a continuous glucose monitor(CGM).  In our case, we have the Dexcom CGM.  CGM shows the blood glucose value every 5 mins.  We can also get the average blood glucose value from the reports tool of the Dexcom application.  This is only a ball park number.  Therefore, the a1c number we get in the hospital is a better assessment of the past quarter.  Of late, my anticipation of this a1c result is becoming synonymous to the exam results.  Sriram calls a1c result as mommy's report card.  He is right.  I'm getting more and more eager about this number these days.

For those who know me well, this would be a surprise as I have never been nervous about the exam results itself all through my school and college years.  So, what's so unique about my situation now?  Exam results in your school and college are more of a reflection of how you studied and of course how you did in those few hours of examination.  I don think that those results affects someone life in a profound way in most cases.  It didn't for me.  But, a1c on the other hand indicates how much of a sugar one's body is handling.  This directly correlates to the long term health of kidneys, eyes, heart etc.  As a result the a1c is a window to the future to a certain extent. Diabetes is mimicked as a silent killer.  This just means that the impact of high blood sugars on various critical organs could be fatal in the long run.

Diabetes was in the background pretty much through out my life as my grandfather had Type 2 diabetes.  Even in my earliest memories, I remember rest of family saying that we shouldn't add sugar in his food because his sugar is very high.  I always thought that managing diabetes was as simple as not having sugary foods.  He passed away at the ripe old age of 80 due to a heart condition.  Neither me nor the rest of family, discussed or even thought about the root cause of his heart condition as he was pretty healthy and independent up until a few months before his demise.  He has had Type 2 diabetes for about 40 years by then.  I have few other relatives facing long term complications such as kidney failure.  They are in their 60s and each of them has had Type 2 diabetes for over 30 years.  Its scary to think that Sriram would be as old as I'm right now 30 years down the line.

I vividly remember talking to Sriram's friend's mom few days after his diagnosis.  She mentioned that her cousin has Type 1 diabetes and he is waiting for a kidney & pancreas donor.  Lot of people would get upset when they hear such things in the first week of diagnosis.  I didn't, because I can clearly see that she was thinking out aloud as she was processing the news I just gave her.  It struck me for the first time that the long term complications of this condition are very real and not so long term for my son.

Sriram's a1c turned out to be 8.1 in our August 2017 appointment.  I started listening to Scott Benner's Juicebox podcast around that time.  I realized that the way we are managing Sriram's blood sugar is very rudimentary manner.  Up until then we never gave any extra insulin within 3 hours as we were told that correcting blood sugars would amount to thought it would lead to insulin stacking and it was ok to be in 200s.  This was the advice we received on the first day of the appointment.  Now that we have the CGM it didn't make sense to wait for 3 hours.

We made a lot of changes to the way we manage his blood glucose levels since.  We try to keep his blood glucose with in 140, which is close to the non-diabetic range.  Some days are better than others. There has been days when we have managed to breeze through ice creams and smoothies.  But, we have seen days when we have felt that we are at the mercy of diabetes even with a simple chocolate milk from Starbucks.  So, is it just a question of luck.  No, I don't think so.

Successful management of blood glucose levels in the long term calls for a lot of learning and discipline.  Does all this guarantee a hale and healthy full life for Sriram?  Probably not.  Each and every one of us has a risk factor for a number of health conditions.  But, with diabetes, that risk factors increases by a component of X.  We are just working on pushing out that factor of X as much as possible.

On the brighter side, I'm seeing people like Dr.Stephen Ponder who have successfully navigated this condition for over 50 years.  But, lot more people have perished due to the long term complications.  We have to be cognizant of the fact that the folks that were diagnosed in the last century didn't have the state of the art gadgets such as the CGMs, tubeless insulin pumps, Artificial pancreas with advanced algorithms etc.  Along with all these gadgets, we also have a number of online support groups and blogs where we get a wealth of information.  Lot more than any one single person can digest.  Therefore, I feel as though I don't have a reason to fail.  I don't have a reason to fail my son.

Finally, Sriram's a1c went down to 6.0 this quarter.  We have managed to bring it down consistently from 8.1 to 7 and then to 6.3 in our earlier appointment. I thoroughly understand that we won't see this kind of reduction every quarter and there would be a saturation point.  Sriram plays a huge role in managing his Blood Glucose.  I hope the teenage hormones would not cause a havoc.  Oh, I just scheduled our next appointment for the end of August.  Looking forward for a peaceful summer break!

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