Why do I need to check my blood sugar if my A1C is fine?

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The following transcript has been edited for length and clarity.

Ginger Vieira: Welcome to Collab Conversations with the American Diabetes Association and Beyond Type I. My name is Ginger Vieira, and with me today, Dr. Cynthia Munoz, President of Healthcare and Education at the American Diabetes Association. Thanks for joining us.

Dr. Cynthia Munoz: Thank you, Ginger. It’s a pleasure to be here.

I would love to pick your brain now, about why someone should check their blood sugar regularly if they feel like their A1C is all already in their goal range?

This is such a good question, Ginger. So, let’s say that you have either worked really, really hard to get that A1C down, or let’s say that you’re pleasantly surprised when your healthcare provider says to you, your A1C gives you a number. And that number is in that target range that your healthcare provider and that you have wanted. Why keep checking?

Sometimes I explain it this way. The A1C is an average number that gives just an idea what blood sugar levels have been during the past approximately three months. But every time that you check your blood glucose, either by poking or pricking your finger or you have some type of sensor that’s checking your blood sugar, you are getting the number in the moment. When we have an A1C, that’s giving us an average of all your blood sugar levels during the past three or so months, it doesn’t really give us the full picture.

And so it tells us it is this number, but it doesn’t tell us all of the numbers that led to this average. So by checking the blood sugars, you are better preparing yourself for that healthy A1C, because it gives you information that allows you to make decisions that will keep those numbers in your target range as much as possible.

I think a lot of people aren’t taught by their healthcare professionals, ’cause there’s such little time when you’re at the doctor’s office, that your A1C translates to an average blood sugar level, like an actual level. So it’s 6.8, which translates to a specific blood sugar level. And you can think about, well, it’s not like you’re just sitting at that one level all day. There’s this big range up here and below. And if you’re not checking your blood sugar, you might not know that two hours after eating, your blood is a hundred points higher than what your A1C implies.

That’s right. So like you said, a lot of times, people may be told this is your A1C, but may not get a good understanding of what exactly it means. It is average. So it doesn’t really give us that full picture. And it also doesn’t help us appreciate how many things are affecting a blood sugar level from moment to moment, Whether it’s what we’re eating, what we’re drinking. Stress, it can be so many different things. And again, the only way we’re really going to know where our blood sugar is at this moment and if I need to do anything to bring that number into range, the only way is really going to be by checking that blood sugar.

And if you’re, let’s imagine someone who would benefit from checking their blood sugar more. Let’s say their A1C is in the high 6’s. And that’s in a healthy general range. It might be a little higher than your actual goal, but they’ll think, well, high 6’s that’s pretty good. That’s near my goal. If you’re checking your blood sugar, you could actually pinpoint what part of the day your blood sugar is above your goal, and then apply certain medications or certain changes in your lifestyle, or even simple changes in what you’re eating for dinner, for example, to help bring it down, even just the littlest bit and smooth out those kind of roller coasters or spikes that you wouldn’t be aware of with just an A1C level.

Right, Ginger. And let’s say you have that A1C in the 6’s. We know that blood sugars are changing all the time. So because you get an A1C that’s in the 6’s and let’s say, you’re feeling good about it. Your healthcare provider is feeling really good about it. I would guess that you probably want to keep your A1C in that range. And we can all appreciate that diabetes is complicated. And wouldn’t it be nice if you could take a break and not pay attention to those numbers?

Let it maintain itself.

But we also need to understand and have compassion around the daily demands of diabetes, which is like to refer to them as…we need to have some compassion and to understand that managing blood glucose levels is a constant. Paying attention to what those levels are is really important. When you get those really healthy A1C, wonderful. You want to keep them there. So you need to keep attention to those blood glucose levels in order to help them stay within that target range as much as possible.

Well, thank you, Dr. Munoz. It’s obviously a complicated thing in some ways, checking your blood sugar. But it’s really simple too. It’s just taking the time to check, and even write it down so that you can bring it to your next doctor’s appointment and talk about your numbers.

Yeah, absolutely. The more blood glucose levels that you have available to yourself and to your doctors or to your healthcare team, the more you can have a conversation about any adjustments that need to be made, but also opportunities to praise the good work, the hard work that you’re putting in.

Good point. Well, thank you so much.

You’re welcome. Thank you.