Life With Type 2: Good Enough for Government Work

I remember realizing a few years after being diagnosed with type 2 that few authorities were urging me or any other older type 2s to drive our A1c’s much below 6.5%. There were several reasons behind that lack of urgency, including research-derived fears that too tight a control of blood sugar levels could lead to cardiovascular problems.

The jury’s still out on that, since there have been conflicting studies about the good or bad of tight control. But the current U.S. recommendations for “good” A1c’s hover at 6.5% for younger people and 7.0% for duffers like me.

Translated into more accessible terms, those numbers are:

• 7.0% A1c = 154 mg/dL
• 6.5% A1c = 140 mg/dL
• 5.9% A1c = 123 mg/dL (this is near the top of the pre-diabetic range)
• 4.5% A1c = 83 mg/dL (this is considered normal)
• 4.1% A1c = 71 mg/dL (readings below this level can be dangerous for type 2s)

Those first two numbers—154 and 140 mg dL— are pretty high compared to the three that follow. It unsettles me a bit to know that a “pretty good” A1c of 7.0% has a blood sugar level 86 percent higher than normal. Wow.

Knowing that this is considered an acceptable number by the diabetes powers that be, I’m reminded of an old saying, “Good enough for government work.” It has a negative connotation, namely that it’s good enough to pass muster in a bureaucracy where you can’t be fired, but wouldn’t make it in the real workaday world. (My apologies to government workers who may be reading this. As individuals, many government workers are dedicated, wonderful people. But as a whole, most government bureaucracies—think Department of Motor Vehicles—are under no obligation or pressure to produce good work.)

I think the 6.5% and 7.0% recommendations are based on some unavoidable insights: People can rarely stick to the kind of rigorous food and exercise regime that drive down A1c’s. (I know I couldn’t. I got down to 5.6% soon after my diagnosis, but over the years crept back up to 7.0%). But even the people who can stick religiously to good eating and exercise habits have to face the fact that type 2 is progressive. We can go at it hammer and tong, but sooner or later the disease, in a way still unknown to us, wears at our best efforts.

The very slender silver lining here is that as we age, fighting to dramatically lower high blood sugar counts doesn’t really seem to make as big a difference as researchers once thought. It may be that our bodies have learned somewhat to live and cope with higher counts. Or perhaps the slow damage to our organs over the years reaches a point where there’s not a heck of a lot we can do to undo it. Driving our numbers down becomes less necessary.

I’m not advocating fatalism here, a weary acceptance of the things type 2 does to us. I’m just saying that few of us are equipped psychologically to make type 2 the main focus of our efforts and lives. It’s easy to see how we can slip into an attitude of “good enough for government work.”

Maybe that’s sufficient. Licenses still get issued, the mail still gets delivered, and most roads stay pothole-free—perhaps not at the level of service we’d like, but good enough.