Out of curiosity the other day, I googled “Type 1 diabetes diagnosis” to see what came up. I wanted to put myself in the shoes of someone who was newly diagnosed since it’s been almost 20 years since I or my family were in that spot.
Googling helped me get really clear on the information newly diagnosed families have access to not only from their doctor but as they begin doing research on their own.
Not to my surprise, I found a lot of emphasis on A1c as a marker of success. And while some people may say that A1c doesn’t matter as much anymore and the time in range + standard deviation (the fluctuation of your blood sugars) are more important, I don’t believe we should throw A1c out the door just yet.
I’ve found over the years in my diabetes health coaching practice that where a client’s A1c is is indicative of where a lot of our focus and time together needs to be spent. It’s a quick snapshot of what holes may need to be filled that will effectively get them to lower their A1c while increasing their time in range and feeling more empowered and in control.
In order to articulate this, I broke different A1c levels into 4 brackets, where no one bracket is better or worse than the other. It’s simply a tool to help guide you to where to shift your focus if you’re working on improving your blood sugar control.
10.0%+ A1c Level
The focus for this first bracket is fear of low blood sugar, relationship to insulin/diabetes, and relationship to self.
When clients come to us with A1c’S 10% or above, there is a ton of mindset work we do to help them rework their mindset beliefs holding them back.
The most common roadblock preventing people from lowering their A1c below 10.0 on their own is a debilitating fear of low blood sugar. They rather stay high because a “slight drop” in their mind means they’ll keep dropping and won’t stop. They feel terrified that they are in danger.
A fear of sitting below 200 may sound dramatic to some, but one bad low instance can sit in your body like a traumatic experience that’s hard to just “shake off”. We’ve found that therapy for the trauma along with our coaching may be necessary for this type of progress.
Not everyone has a fear of low blood sugar though, and if it’s not that present, there’s usually work that needs to be done around the relationship to taking insulin (getting rid of that fear of weight gain), and relationship to themselves and what is possible for them once they start to get their blood sugars in a better range.
8.0%+ A1c Level
The focus of this second bracket is fine-tuning ratios, education/relearning, and building self-awareness around your patterns.
The types of T1D clients we usually see in this bracket are the ones who are actively managing their diabetes but feel frustrated and like nothing they do is working. They may fall into the “diabetes is such a burden” trap and become resentful towards it.
We recently had a client in our Decide and Conquer Group Coaching program for female T1D’s who had diabetes for 14 years and came in at an 8.3 A1c. She’s currently at a 6.4 A1c 1 year later and is a perfect example of what’s possible when you shift your focus.
This particular client was feeling really lost and defeated but really just overwhelmed with all the pieces. She needed her handheld and a process of where to start. With the strategic step-by-step focus on getting all her pump settings solid, learning new tools to make managing her diabetes easier, equipping herself with more knowledge and understanding of how her body works, she was no longer held back and more easily lowered her A1c.
7.0%+ A1c Level
The focus of this third bracket is: introducing new routines and strengthening new habits around food, exercise, and stress regulation.
Something I hear a lot is, “I’ve never been able to get below a 7.0 A1c and I really want to.”
If this is you, know this: the set of tools required to lower your a1c from an 8 to a 7 and then a 7 to a 6 are very different.
This bracket requires building consistency with new habits that support you holistically: mind and body.
You may want to explore increasing your insulin sensitivity, managing stress, and create more consistent habits around food and exercise.
6.0%+ A1c Level
The focus of this last bracket is: tightening up time in range, correcting at lower numbers, and asking yourself if what you are doing feels sustainable.
When I was at the height of my perceived diabetes control, I had a 5.7 A1c. To get there, I decided to completely stop eating anything “bad”. No french fries, no pizza…nothing. After doing this for a while, it felt like I was depriving myself of the joy that comes from sharing a meal with family or friends. Eating that salad at home before meeting up with everyone wasn’t sustainable, or a positive way (for me at least) to have a healthy relationship with food.
That low number isn’t worth chasing if you don’t feel good in the way you are doing it.
As you work on your diabetes management in this bracket, let your decisions come from a place of your highest holistic good.
Each level of diabetes has necessary reflection and an inward working component that you simply cannot skip. Regardless of the stage you may be in today, it will always require work. Over time, the number will stop feeling like an enemy and become a friend. It will be there as a support system to guide you to your next level of diabetes management.
And remember, before reading your A1c results, take a deep breath in and remember that the number does not define who you are, you do.
If you are a type 1 diabetic and have been trying to lower your A1C for a while without it feeling easy, register for a free training on my signature A1C Shift Method. Over 2,000 people have attended this year alone. You can register HERE.