(Special disclaimer: I am posting specific test results because I think it's necessary to tell the story: my numbers only compare usefully to my numbers, and maybe not even that. I'd also like to stress that I never claimed to understand diabetes.)
In my situation, as with many oral-medication-only Type 2 patients, the basic expectation as far as blood glucose testing is that I do it once a day, before breakfast. This test is not a basis for short-term decisions, as it likely would be for an insulin user. It's a data point that enables me and my doctor to watch for trends. Type 2 is a progressive disease, and keeping an eye on those morning numbers is an important way to watch for signs that an alteration in the treatment plan is in order.
Unfortunately, I sometimes get out of the habit of testing, and sometimes have gaps of several weeks between tests. Coming off such a gap a few weeks ago, I noticed that my morning tests were often 30 points or more higher than my target range. I wasn't too concerned at first, because I know I have a pattern of going a little low at night and having the morning test show the aftermath of the glucose dump from my liver. But when those morning numbers stayed high pretty consistently, I decided to do some tests during the day. Those additional tests seemed to me to show that I was spiking more strongly from my meals and coming down more slowly. I also noticed that I'd spent a lot of time in recent weeks feeling like used gum.
So, in the hopes of confirming or contradicting what I suspected, I did one of the home A1c tests. My understanding is that those are not necessarily clinically accurate but do tend to be in the neighborhood. The result of that test was 7.6, a jump of a point and a half over the 6.2 I'd gotten at my last doctor's visit.
So, I made an appointment to see my doctor (I was due anyway), and spent the next ten days eating a drastically reduced amount of carbohydrate to try to at least feel better until I could get some help. My numbers did seem to improve, and I did feel better. It was really, really, hard, though, and it was only partially successful. (Even for the short term, I wasn't exactly perfect. T-shirts for the "Great Tortellini Incident of 2012" are still available - order yours today!)
So, today I had my doctor visit. I told my doctor (who I love) was was going on, and she was interested to compare the results and she gave me a checkup. Feet good, blood pressure good, cholesterol iffy but not worrisome.
And the A1c?
5.7. The lowest I'd ever had, and nearly 2 full points below the home test I'd done ten days before. And, to the best of my knowledge, I've never been more than borderline hypoglycemic.
We talked about various possibilities for the discrepancy (I could have screwed up the home test, there was a reason to temporarily distrust their unit, etc.). And as we did so, I felt scared, almost desperate. I needed help, and the person that I had counted on to give me that help was about to give me a (metaphoric) gold star and send me on my way. I was looking down the barrel of a significantly diminished life in which I often didn't feel well enough to be my best at my job.
And so I gathered up ALL my feeble stock of patient empowerment, and I borrowed some from my friend Scott S., and I spoke up. I reiterated how much the test result was contradicted by my daily experience. I said that while I did care about my liver (this made the doctor grin: she immediately got the distinction I was drawing between long-term and short-term results), it was how I felt that was most important to me.
And, so, we're trying a tweak. I take my diabetes medicine twice a day, and we're doubling the morning dose. I'm to watch things carefully for a while and let her know if I'm having problems. In three months, she'll have me get an A1c from a real lab.
Have I mentioned that I love my doctor?
We'll see how it goes.