IS THE “AVERAGE” REPORTED ON YOUR BLOOD GLUCOSE METER THE SAME AS eAG?
No. The “average” on your meter only reflects the average from the readings you performed. If you only check a few times a day like most people, you only have a few points of data, and not the constant data that’s represented by an eAG or A1C check. The eAG reflects what your blood glucose readings were 24/7 for 3 months.
ONCE YOU HAVE YOUR RESULT
YOUR A1C IS HIGHER THAN 7%. WHAT NOW?
If your test result is higher than your target, immediately discuss with your health care providers what you can do to improve your results in the future. Don’t wait until the next visit! Consider your management plan and ask yourself:
HOW DO YOU CALCULATE YOUR eAG?
You can calculate your eAG using your current A1C result. The formula is as follows:
(28.7 x A1C) — 46.7 = eAG
It’s probably been a while since math class, so an example to illustrate may make it more clear. Let’s say your A1C is 8.2%. For the formula, you treat your A1C result simply as a number and not a percentage. So to calculate your eAG, you would first multiply 28.7 by 8.2 (your A1C):
28.7 x 8.2 = 235.34
Now, you would take this number, 235.34, and subtract 46.7:
235.34–46.7 = 188.64
Then just round up to the nearest whole number, 189, and you have your eAG. In this case, that would be an average blood glucose of 189 mg/dl over a 3-month period. Seeing this should illustrate how eAG is useful. If your doctor says you have an A1C of 8.2%, you probably realize that is high, but it can also be just another number. However, if your doctor says your blood glucose level averages 189 mg/dl, you have a much more concrete idea of what that means. Mostly, it means you’ve got some work to do!
Learn what options your health care providers have to suggest. A high A1C is not simply your fault; it is a problem to be dealt with by you and your health care team.
WHAT IF YOUR SELF GLUCOSE CHECKS DON’T MATCH YOUR A1C?
It is possible your blood glucose meter may need to be replaced, or you’re not following the manufacturer’s guidelines. However, it’s more likely that the variation comes from the different nature of each test. An A1C only reports an average—it cannot show daily fluctuations. Conversely, you may need to do your self glucose checks at different times of the day. Always checking at the same times of day will limit your ability to fully understand your glucose levels over a 24-hour period.
Remember, an A1C result of 7% compares to a blood glucose average of about 150 mg/dl. Think of how many different ways you can mathematically achieve this average, even with just two blood glucose numbers obtained each day during a month. Consider the individuals below:
All four of these individuals have the same A1C, yet their control is obviously not the same. Jill and Jane are experiencing big, out-of-control swings, and Joe and John are not consistently in the 70–140 mg/dl range. Having this type of information can put your A1C results into perspective.
WILL CONTINUOUS GLUCOSE MONITORING REPLACE A1C?
Continuous glucose monitoring (CGM) appears to be the future of self blood glucose testing. By using a device that continually checks blood glucose levels, these systems provide a complete view of levels throughout the day, improving glucose management and overall self-care. However, CGM devices aren’t perfect yet and many are expensive or hard to get; more work certainly needs to be done. Whether they will replace A1C tests remains to be seen, but it’s hard to imagine that an overall glucose snapshot of a 2–3 month period won’t be useful in the future. Likely, CGM will be an excellent tool to use alongside an A1C check. For now, all individuals with diabetes, whether they use a meter, or CGM devices, should have an A1C check to be evaluated alongside daily readings, whether from a meter or a properly calibrated CGM device.
DO YOU STILL NEED TO KEEP A BLOOD GLUCOSE LOG BOOK?
There’s no replacement for a well-kept glucose log book. Always take your logbook (or a meter with a memory function) to appointments. Ask every member of your health care team to review the information, including your educator, nurse, pharmacist, or dietitian. Compare your logbook results with the A1C results on a daily, weekly, or monthly basis and not just every 2–3 months.
MORE RESOURCES TO EXPLORE
BOOKS
Diabetes A to Z: What You Need to Know About Diabetes—Simply Put, 5th edition. American Diabetes Association; Alexandria, VA, 2003.
WEBSITES
American Diabetes Association Website ……. WWW.DIABETES.ORG
3 How to get the most out of your visit to the registered dietitian
Visiting a registered dietitian (RD) seems to be as popular as going to the dentist to have a cavity filled. Maybe less so. Perhaps people cringe at the thought of exposing their personal food choices and body weight to a RD. Perhaps they expect to be scolded or judged. Unfortunately, many physicians have not exactly helped put these perceptions to rest. In some cases, the physician may even use the threat of an appointment with a RD as some strange motivational tactic to encourage patients to change behaviors. Not surprisingly, this tactic doesn’t work, but it does turn the RD into the boogeyman. In other cases, health care professionals will make offhand, negative comments such as, “You won’t be able to eat THAT anymore,” and then set up an appointment without a patient’s consent, creating a scenario where the individual anticipates having things taken away from them before they even step through the door.
Here’s the good news about a referral to a RD—it is not punishment, it is valuable. The RD is a vital member of your diabetes health care team and a terrific source of nutrition information. In fact, most people find that a RD expands their food choices as opposed to limiting them. Considering the other options for nutrition education—food advice from a copied menu or an article from a popular magazine—it’s not surprising that most enjoy the special attention and conversation
WHAT’S A RD?
Once you realize a RD is not a dietary dictator or the food police, you might wonder what a RD actually is. Following are some characteristics all RDs share.