This Disaster Averted is not just about one patient but about many who take insulin. Most think high A1C means one needs to increase insulin. Not always! Remember, A1C is an average. Just because someone has an A1C of <7% doesn’t actually mean glucose is managed.
Patient after patient whom I see who has an elevated A1C often has frequent low glucose levels. How do I know? Not usually by fingersticks; one misses so much information by just using fingersticks. I have learned by CGM. Often I will see hypoglycemia followed by hyperglycemia. Often this is due to higher basal insulin than is actually needed. Sometimes it is because the insulin to carb ratio or the correction is not accurate.
Main learning: Just because A1C is elevated does not mean you need to increase the insulin. It could mean lower insulin, but make sure you have the information first.
- AIC is an average. It does not give the whole picture, neither do fingersticks. Fingersticks are a picture, CGM is the “film.”
- If a patient’s A1C is elevated, do not automatically treat with more insulin.
- Get more information before changing treatment. Whether it be food, activity, meds or the many factors that can influence glucose levels, get more information, including the use of CGM to see the whole picture.
- Review with patient and together make decisions on how best to treat the patient’s glucose levels.
Joy Pape, FNP-C, CDE
Medical Editor, Diabetes in Control
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