This new guideline first crossed my eyes in the form of a **BREAKING NEWS** post on Facebook.
It was posted by the very organization that made the news. (Does anyone else find that just a little bit self-serving and disingenuous?)
But after getting over my disgust over the misrepresentation of (what should have been) a press-release as a groundbreaking, developing situation, my thoughts shifted from the presentation to the message.
And my reaction to the lowering of an A1C target to 7.5% (from something that, I could only guess was something more than that) was a hearty, passionate…
So, somebody, somewhere, decided that for kids under 19, lower A1Cs were better A1Cs.
Don’t misunderstand me. My apathy towards this news has nothing to do with the fact that I’m more than double the age of the oldest person to whom this applies. It has nothing to do with the fact that it was presented in such a manner. Nor does it have anything to do with the number itself, or which side of the number I spent most (if not all) of my years between diagnosis and my nineteenth birthday.
I simply don’t believe in targets. I believe nothing good can come out of them. Especially non-individualized targets that sweep across a large portion of the diabetes population.
My thought is this: I know that the “normal” non-diabetic A1C is somewhere in the 4’s or 5’s. I also know that being in the 5’s is probably better than being in the 6’s, and being in the 6’s is better than the 8’s, and the 8’s is better than the tens, and the tens are better than the teens… and so on. This, I believe, is irrefutable.
I also know that I have never been in the 5’s since diagnosis, nor do I have any aspirations to get to the 5’s (yes, this is probably my first disclosure of what my A1C is…not.)
What I do know is this: I want my A1C to be as low as I feel comfortable with. (“Comfortable” is a loaded term: a combination of not going to bed in fear of a low and not restricting my diet and lifestyle to the point of “why bother?”)
I will not set a target value, and I will not measure myself against some arbitrary number. I will measure myself against my prior A1C results and make a mental note of what I did differently over the past quarter-year than in the three months prior. Maybe I’ll learn something from that. Maybe I won’t.
But I’ll continue to try to do my best. Day after day, week after week, month after month, quarter after quarter.
And whatever happens … whatever X-point-Y-percent gets reported back to my doctor, I know it’s a reflection on not only how hard I tried, but on what I tried to achieve.
Seven-point-five is an arbitrary and meaningless number:
- To the eight-year-old who’s cruising along at a six-point-seven, it may suggest that he should start choosing chocolate milk with his school lunch rather than white milk.
- To the fourteen-year-old whose A1C hovers around the 14%, it may be devastating. He couldn’t get over the bar before, and now it’s been raised. It’s hopeless and maybe he should just give up.
- To the eighteen-year-old who’s about to move away to college and has no idea what lies ahead, it may be just the push he needs to start organizing his thoughts, his routines, and his life.
Three very different hypothetical scenarios, three very different possible reactions.
But there’s no doubt in my mind that these school-age kids, who are graded on everything they do, see the chances of achieving a passing grade getting a bit slimmer.
Why can’t we just tell these kids (and their parents) that they should just try to do their best, and leave it at that? Whether we’re talking mathematics or weightlifting, nobody expects everyone’s best to be the same. So why should it be when it comes to A1C?
In my mind, that ADA-publicized number…. whatever it is…. is completely meaningless.