Why the A1c May Not Be So SMART

Melinda Seed writes for Twice Diabetes
Melinda Seed writes for Twice Diabetes

Achieving a particular A1c is much touted as being THE goal or target for people with diabetes to achieve.

When you’re trying to improve your control and/or get back on track with diabetes the A1c may not be such a smart goal to focus all your attention on.

The theories behind goal setting(and I have all those boring corporate development days to thank for this) tell us that to be effective, goals need to be SMART.

Specific, you need to be able to state exactly what it is you want to achieve.

Measurable there needs to be a way to demonstrate what you have achieved

Achievable aiming high (or rather low in the case of thea1c) is fine but goals need to be within the realms of possiblity and they need to be things that YOU can achieve. It’s no use saying your goal is to be cured in 5 years.

Relevant The goal should tie in with your greater life purpose or aims.

Time-bound You need to set goals to be achieved within particular periods of time. A goal for 50 years time isn’t going to motivate you much for the next 49 years.

The A1c scores highly as a measurable and time-bound goal but I struggle to see it as specific, achievable and relevant enough to really help me in my day to day battle with the random number generator aka my glucometer.

The a1c is a number that comes back from the pathology lab, it doesn’t reflect the day to day struggle you have with carb counting, hypo rebounds, stress, the weather and goodness knows what else to keep your blood sugars in check.  Whilst I know what I do impacts it and I can do much to reduce it, sometimes trying to do everything  to be  the perfect diabetic just isn’t achievable, specific or relevant to my life. I need smaller, goals that I have mastery over. As I have small wins, my confidence grows and I can move onto other achievable goals to improve my control.

When I’m trying to reel my diabetes back in from a little break,  SMART Goals that I’ve found useful have been things like:

  • Test my blood sugar at least x times per day and take appropriate action on the results.
  • Count my carbs really diligently for a week, experiment with weighing food and reading packaging to ensure that portion sizes haven’t crept up.
  • Set my alarm and check my bsl at 1am for a few nights. Act to change my basal appropriately if necessary.
  • When I was on shots, (prior to the pump) making sure that I had them at as close to exactly the right time as possible.

Of course when I focus on achieving these goals the result is an improvement in the longer term goal, or target of improving my a1c.  So next time you’re at the endos, consider asking for one specific, measurable, achievable, relevant and time-bound goal or strategy to try that would have the greatest impact on your a1c. If it’s not SMART tell them why and get one that will work for you.

This strategy also works a treat for those doctors (usually GPs or non-diabetes specialists) who feel it is their place to lecture you about your a1c being too high. Put them on the spot and ask them for a specific recommendation you could implement to improve it, it’s amazing how quickly they shut up when put on the spot.

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