I have had type 1 diabetes for 18 years, have been on an insulin pump for the last three years, and my blood glucoses have been fairly good and stable since. About 60-80% of my preprandial values are below 180 mg/dl [10 mmol/L] and values above 250 mg/dl [13.9 mmol/L] are extremely rare. Despite that, my hemoglobin A1c is disappointing (mostly around 9-10%). Can anybody explain the apparent discrepancy between blood glucoses and HbA1c?

The first place to start is by setting lower pre-meal goals for your blood glucose control. Any blood sugars above 200 mg/dl [11.1 mmol/L] are high. This is not an emergency, however, you should work your physician on what your target blood sugars should be. It is okay for it to change over time. This is the usual progression towards better blood sugar control. Keep up the hard work. It is worth it.

JTL

[Editor’s comment: The American Diabetes Association recommends blood glucose target values of between 70 and 120 mg/dl [3.9-6.7 mmol/L]before meals and less than 180 mg/dl [10 mmol/L] after meals, with a glycated hemoglobin level less than 1% above the upper limit of normal, and without significant hypoglycemia.

SS]