The Etiquette of the A1C

Type 1 Diabetes Blog

The Etiquette of the A1C

Have you ever wondered why so many people share their A1C’s online? I have.

I recognize that having a low A1C is something most people with diabetes strive for, and it’s an accomplishment one would certainly want to celebrate (especially if they worked hard to achieve it), but sometimes I wonder if there’s too much focus placed on just one tool that measures our blood sugar control. I’m also curious about how sharing one’s A1C can emotionally affect the other T1D’s around them.

There are so many things that determine our health in relation to diabetes. Your A1C, the blood test that reflects your three month blood glucose average, seems to be the most recognizable way to assess how a patient is doing with their management. However, in recent years, with the surge in popularity of CGMS (Continuous Glucose Monitors), and other wearable devices like the Freestyle Libre, there seems to be shift of focus in many minds to the “time in range” as opposed to A1C.

Oftentimes, experiencing constant highs and lows can influence the A1C result in a way that makes it look like someone has good control, but in reality, their low average is due to too many hypos, and doesn’t reflect the true balance we all need to be seeking. This is why an A1C isn’t always the best way to determine how one is doing with their management. I have had many friends and members of the PODS meetups share stories of times where their A1C was great, but they didn’t feel they had the balance or control they were really looking for. Many echoed the sentiments of too many lows and too much variance in what their numbers would be.

Being a part of the diabetes online community, specifically the diabetes Instagram community, I have seen many profiles where people proudly share their A1C. However, I typically only see A1C’s in the 5’s or 6’s… occasionally the 7’s. I can’t help but wonder if those struggling to reach their goals feel disheartened by seeing the low A1C’s of others.

And what purpose does posting one’s A1C in their Instagram profile really serve? Well, for some people, it holds them accountable. If they have worked tirelessly to achieve a number they felt confident enough to share, then good for them! By posting in a public forum, it starts to become part of their identity, and the pride they feel can be an excellent tool for continued health and perseverance towards optimal diabetes management. At the end of the day, we all need to remember that there are different roads to get to the same destination, and we each have our own tools and strategies to get there.

For me, I don’t choose to share my current A1C in my profile. However, I will share with others within the DiabetesSisters PODS group setting, or in other peer support forums, what my A1C is now… and what it once had been! It’s not about being secretive, it’s about being selective, and trying to be sensitive to the feelings of others. I know what it’s like to feel like I’m “failing” at diabetes because I don’t have the same results as my fellow Type 1 friends. These days, I realize that I’m more than just a number, so it doesn’t bother me to tell others that at one time in my life my A1C was as high as 18. Normally the reaction of others is “I can’t believe you’re alive!”, to which I typically reply “Me either.”

As far as sharing what my A1C is now, I always like to bring into the conversation the remembrance that we are ever-changing beings. We can be grateful for where we are now, but we must never forget the work that still must be done. Reflecting on the past, acknowledging our triumphs, as well as downfalls, and preparing for the future ahead is what will help us most as we continue on through life.

So whether or not you share your A1C online, it’s important to remember that each one of us is living our own life with diabetes. For some, the road traveled is a bit bumpier, filled with potholes, dead ends, and even a detour or two. For others, there seems to be an ease and grace to this diabetes dance. It’s those people who can become beacons of light for others who may be lost. I implore anyone and everyone to share the figts they have with those around them. At the end of the day, we are all in this together, and when we mindfully support and encourage each other, the world becomes a much better, brighter place to be.