We all know it’s coming at some point. Twice a year, in fact. You try to dismiss it; ignore it and pretend it will never ever happen. But it allllllways arrives sooner or later – plonks itself on the doormat oh-so-innocently, creeping up on you when you least expect it, late enough to think you might have got away with it.
The dreaded HbA1c appointment.
I don’t know what it is about clinic. You know you’re going to have a check up every six months, yet no matter how many years go by, it always seems to come around too quickly. And as good as you know your blood sugars have been (hopefully), the prospect just fills you with dread. One flimsy piece of paper… “An appointment has been made for you to attend the Diabetes Clinic…” VOM.
Now for the non-diabetics amongst us, a HbA1c is like the end of year exam. It’s the assessment above all assessments of your status as a good/bad diabetic. I know, I know, there’s no such thing… but you don’t want to face that Demon Headmaster-esque stare that occurs when your blood is taken and the nurse/doctor in question pulls “that” face.
Must try harder.
So, the HbA1c is the 2/3 month average of your blood sugar levels. We test our blood sugar levels multiple times a day, so this is nothing new. The aim is to keep it within that glorious range of between 4 and 9 mmol/L. So the HbA1c is just the average of this over a couple of months. I’ve no idea what that weird letter/combination actually stands for, and I have no desire to find out. There is a target, and if the target isn’t met, you know you’re probably about to face *that* look – if not from the nurse, then more than likely from yourself. Seriously, I think a good proportion of the issues diabetics face stem from the pressure we put on ourselves to be perfect at this bloody impossible disease. But there is something about a HbA1c that, the closer it looms, the easier it suddenly becomes possible to say no to that piece of cake.
You’d be big fat COR-RECT (game show stylee) if you’re suddenly thinking “Hang on a minute missy, that doesn’t really appear to make any sense.” It doesn’t. If you only behave for the 2/3 months ahead of your bi-annual test, you’re only being good a maximum of 6 months of the year. And I reckon behaving 50 per cent of the time isn’t enough to bypass all these glorious repercussions we’re trying to knock on the head. So what’s the problem? Just behave all the time, goddammit. Sorry folks, game over. Try as you might, it ain’t possible, and it ain’t realistic. You can be good as often as life will allow you, but life has a very turbulent relationship with diabetes. They just aren’t naturally suited. And so when the HbA1c rears its intimidating head, it’s ok to be a little bit nervous, because at no other time is there a result so stark, so quantitative and as such the be all and end all of your status as a diabetic. Dramatic much? We test our blood sugars every day, for crying aaatt laaaaaud. And actually, the HbA1c result it just another blood sugar test. So what’s to worry about?
I think the way I (and many others out there) view these appointments is a reflection on diabetes education and teachings, or certainly my experience of them. OHHH, CONTROVERSIAL. But why otherwise should I feel apprehensive and nervous about something that’s totally in my control? The diabetes specialist that I had when I was a child is absolutely not to blame for this. He would never ever belittle or patronise me about my behaviour or my results. Probably because before I got introduced to boys and alcohol I was only interested in running about and climbing trees, activities which happen to be conducive to amazing HbA1c results. But theeeeen… I went to uni and I was pretty shit at being a diabetic. Granted. But the doctor I had there just did not have a way with words. To the point that every time I’m now told my blood pressure is about to be taken I have a little palpitation because of the fear he’s instilled in me about keeping it low. That’s surely not right? Then, that also contradicts my earlier musings about us needing to have the seriousness of the consequences of prolonged poor control all laid out on the table as early as possible. Confused? ME TOO.
I can appreciate that there may never be a perfect way to instruct someone on how exactly to control their diabetes. It’s about learning it all on your own, because you eventually realise it’s for your own good and if you don’t, your day-to-day life seriously suffers. When it comes down to it, you have to learn these lessons sans any parents, nurses, specialists, understanding partners. The Hard Way. But hopefully not the Too Late Way. No-one tells you that though while you’re wading through the fog of a disease that you’d never heard of before the day you were diagnosed. Hence the need for this very site. Howdy.
So really, if my HbA1c is higher than one would really like it to be, all that will hopefully happen is that we’ll just keep on trucking until we see that fully understand that although we’ll never be perfect and therefore shouldn’t put ourselves under ridiculous amounts of pressure that lead to guilt and god knows what else, good control is actually on whole fully in our grasp, as a result of the decisions we make every single day – every single hour. If we do this as often as possible without sacrificing the fun stuff, the HbA1c will reflect this because it is precisely that – an average that chops off the reading of 17.9 that we just can’t understand, and may quietly disregard the odd occasion when you didn’t quite take enough insulin to cover the chocolate cake. Which we’ll now pass on. At least until after we’ve been to clinic.