How frequent hypoglycemia could be driving up your A1c!

There's a scene in the movie World War Z where the doctor, who is charged with the task of finding a cure or treatment for the virus, describes mother nature as a serial killer who "can't help but want to get caught."  He says that in her weakness, she leaves crumbs that are the clues to cracking her code.
As the plot unfolds, it becomes clear that this is simply a poetic way of saying that solutions often come from unlikely, or even unwanted, sources.

As diabetics, we certainly know this is true.  I find myself always on the lookout for clues to better control.  Since the advent of continuous glucose monitoring (CGM), there has been particular growth in the understanding of hypoglycemia and its relationship to A1c.  Traditionally, high A1c's have been attacked by targeting high blood sugars.  While this is obviously a logical approach, it may not be the best approach for those who suffer dangerous hypoglycemia. 

CGM research indicates that the frequency, duration, and severity of hypoglycemia are not reflected in an A1c.  This essentially means that it is possible for a person with an A1c of 8 to have more hypoglycemia than the person with an A1c of 6.

So what, exactly, does all this mean to us?  Well, the crumbs we find in this research lead us to believe that both reduction in hypoglycemia and A1c are not only achievable, but in some cases exist in a causal relationship.  Think about it; the first thing we want to do when we begin to feel a low blood glucose is to stuff our faces with simple sugar like it's Halloween.  Better yet, we'll eat anything as long as there's carb in it.  There are 2 reasons for this reaction: 1) our brain is telling us that it needs fuel NOW  2) this feels horrible, and we want it to stop NOW (and never happen again). 

Consequently, it's been my experience that most of us tend to over-treat hypoglycemia.  So what comes next?.....a swing into hyperglycemia.  Then we feel horrible again and want to take insulin, right?  Usually not.  The move to hyperglycemia is less noticeable to the brain, and thus tends to go untreated for longer periods.  This, in turn, drives up A1c.

Therein lies mother nature's code.  If we can reduce the number of hypoglycemic episodes, it is very likely that we can effectively reduce almost that same number of hyperglycemic spikes.  This, in turn, brings down A1c. 

All fine and good, but how does one reduce the frequency of low blood sugars?  Stay tuned for more tips in a future post; but in the meantime, I suggest frequent cbg testing, snacks or reduced insulin before and during exercise,  and not going more than 4 hours between meals or snacks.  If and when hypoglycemia does occur, do your best not to over-treat.  Then, test your sugar between 1-2 hours after treating to be sure it has not gone hyper.  Good luck, and let's be less than seven, greater than low!