The Hawthorne Effect: How to Keep Your HgbA1C Below 5.4%

I can’t remembered if I cried,
When I read her A1C,
But something touched me deep inside,
The month it rose a wee…

Okay, I’m no Don McLean. Nonetheless, Nicole and I were almost as shocked as McLean when he read about Buddy Holly’s death that shivery February in 1959. Last April, Nicole’s lab tests offered some “bad news on the doorstep.” She handed me the report with the look of a middle-schooler bringing home an F. The smell of a freshly burned fax hit my nose as I unfolded the paper.

 >HBA1C  0.060

That translates to 6.0%. Yes, Nicole may have type-1 diabetes. But that hasn’t stopped her from sporting a HgA1C that would most non-diabetics would envy (if they had any idea how important such a blood marker is). Sure, she wasn’t in the 4.5% over-achiever club that she once enjoyed. But anything below 5.5% is well within the non-diabetic range.

Here’s what the last year and a half has looked like:

  • January 2014: 5.0%
  • April 2014: 5.2%
  • October 2014: 5.2%
  • January 2015: 5.2%
  • April 2015: 6.0%

6.0%! Where did that come from? What went wrong? What had changed? Was Nicole stopping by the ice cream parlor for a banana split on the way home from dialysis?

Nothing of the sort. She hadn’t deviated from her 20-30 grams per day of carbohydrate diet.

“I think it’s an insulin issue,” I said. “I think we need to go back to logging blood sugars and insulin dosages. We stopped tracking this year. That’s the only difference I can think of.”

Nicole agreed. So I printed out four double-sided copies of the log sheet I created two years ago. There’s a column for recording what Nicole eats (mainly protein, fat and some vegetables). Another for fast-acting insulin doses. Another for slow-acting. Another for blood sugar levels. One-page for each day. Writing down everything makes it easy to review and improve.

After all, we’re trying to do the job of a both the pancreas and liver. Getting it out of the head and onto paper not only makes it clearer, but also less stressful. The more stress involved in balancing the blood sugars, the less likely we may be to do it.

But there’s more to it than that. I think the simple act of tracking, measuring and recording automatically makes us more effective at dosing insulin. It helps our brain realize the extreme importance of balancing blood sugar. This is sometimes called the Hawthorne Effect.

According to Wikipedia the Hawthorne Effect refers to a 1924 experiment conducted at the Hawthorne Works (a Western Electric factory outside of Chicago). Various studies were conducted to see if different working conditions improved productivity. Surprisingly, they found that productivity improved whether an improvement was made or not. Workers worked better simply as a result of them knowing that their productivity was being measured.

Likewise, I think, with blood sugars. Once you start writing it down, your subconscious will immediately become more alert to ways to keep blood sugar levels balanced. In Nicole’s case we realized we could:

  • increase her meal insulin (Regular)
  • get more strict about checking blood sugar levels exactly five hours after her last injection of fasting-acting insulin
  • increase her long-acting insulin (Levemir) doses

Three subtle changes. Steering the boat about five degrees to the left. That’s about all we did.

Last week, we received Nicole’s latest HgA1C: 5.3%!

Pen, paper and the Hawthorne effect. It only takes a minute 3-5 times a day. It’s a tough job, but the pancreas ain’t going to do it. At least not yet, we’re working on that. Until then, the chore of logging and tracking motivates us to reverse type-1 diabetes.

I was singing bye, bye Miss A1C High,
She drove her sugar to the lower so she will not die,
So that glucose test didn’t make her sigh,
Cuz’ it’s under 5.5…


  • Yes, Nicole’s HgbA1C went as low as 4.5%. To find out why we now aim for between 5.0% and 5.4% read The Dark Side Of A Very Low-Carb Type-1 Diabetic Diet.
  • Next week, I have more good news from the same lab test. This time about Nicole’s thyroid.
  • If you would like help maintaining a normal HgbA1C, I am now offering telephone coaching exclusively for type-1 diabetics. If you’re interested, please contact me.

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