A1c not as good as I wanted...

[Mdub]

... but better than the alternative. Back in September of this year I clocked in at an 11.3 A1c. Obviously something had to change, and it did. I started Metformin and Jardiance and a low-carb diet. I also started using a CGM, mostly to keep a close eye on my numbers after eating certain foods and to keep tabs on how well the meds were working.

I am using mg/dl instead of mmol. Throughout this last 3 month period, my EAG has been running 115-120 mg/dl on average. After the 3 months, my A1c came in at 6.4. Certainly better than it was in September, which I am grateful for but it doesn't seem to match what I was seeing on the CGM (E.g a 120 EAG is 5.8 A1c). I have also been using finger sticks to verify the CGM. The finger stick numbers often come in much lower than the CGM, I understand they are two different sources for the levels, finger sticks are close to real-time and the CGM is using subcutaneous fluid so it is a "delayed" number unless I am just misunderstanding things completely.

Either way, was curious if anybody had experienced anything similar.

 

[EllieM]

Hi @Mdub. There are a number of medical conditions (eg anemia) which can mean an hba1c doesn't accurately reflect blood sugars. (Not saying that yours isn't accurate but it is a possibility).

For this reason, I personally would be more inclined to believe the blood sugars, with the large proviso that cgms can be inaccurate (so need checking against bg tests) and bg tests alone can miss spikes.

An hba1c assumes that your red blood cells live for a standard amount of time. If for some reason your red blood cells live for an unusually long or short time, the result can be misleading.

Pitfalls in Hemoglobin A1c Measurement: When Results may be Misleading

Since the beginning of clinical use in the 1970s, hemoglobin A1c (A1c) has become the standard tool for monitoring glycemic control in patients with diabetes. The role of the A1c test was broadened in 2010, when the American Diabetes Association added ...

www.ncbi.nlm.nih.gov

Edited to add, but whatever the accuracy of the hba1c, congratulations on the drop in your blood sugars.

 

[Mdub]

Hi @Mdub. There are a number of medical conditions (eg anemia) which can mean an hba1c doesn't accurately reflect blood sugars. (Not saying that yours isn't accurate but it is a possibility).

For this reason, I personally would be more inclined to believe the blood sugars, with the large proviso that cgms can be inaccurate (so need checking against bg tests) and bg tests alone can miss spikes.

An hba1c assumes that your red blood cells live for a standard amount of time. If for some reason your red blood cells live for an unusually long or short time, the result can be misleading.

Pitfalls in Hemoglobin A1c Measurement: When Results may be Misleading

Since the beginning of clinical use in the 1970s, hemoglobin A1c (A1c) has become the standard tool for monitoring glycemic control in patients with diabetes. The role of the A1c test was broadened in 2010, when the American Diabetes Association added ...

www.ncbi.nlm.nih.gov

Edited to add, but whatever the accuracy of the hba1c, congratulations on the drop in your blood sugars.

Thanks for the excellent and informative response, I will talk to my GP about it. Incidentally, I have never been diagnosed as anemic but my mother was so that is very interesting to say the least. Thanks again!

 

[Antje77]

I just wanted to add that getting your hba1c from 11.3 to 6.4 in only 3 months is absolutely amazing!

 

[Mdub]

I just wanted to add that getting your hba1c from 11.3 to 6.4 in only 3 months is absolutely amazing!

Well thank you! I am certainly encouraged by the improvement and working hard to maintain my progress. I think it's good to feel like you are getting somewhere and not continuing to spiral downward.

 

[EllieM]

Thanks for the excellent and informative response, I will talk to my GP about it. Incidentally, I have never been diagnosed as anemic but my mother was so that is very interesting to say the least. Thanks again!

Of course, have you considered that your hba1c may still be reflecting some of those very diabetic levels from September?

In any case, if you are skeptical about the hba1c, you could ask for a fructosamine test, but it might be worth waiting to see what level you get in 3 months time?

 

[Mdub]

Of course, have you considered that your hba1c may still be reflecting some of those very diabetic levels from September?

In any case, if you are skeptical about the hba1c, you could ask for a fructosamine test, but it might be worth waiting to see what level you get in 3 months time?

Yes, I have considered that it could be carry-over from the high levels I had back in the Fall. I have an appointment in about an hour and half to go over these new labs with my GP. I will consider what he says about it and go from there I guess. He won't "sugar-coat" (no pun intended, well maybe...) it either way, I really like that about him.

My guess is he will say, "keep doing what you are doing, see you in 3-6 months..."

 

[Resurgam]

Although there are charts giving equivalents, they don't always equate. I got down to a Hba1c of 42 and thought I would eat fewer carbs each day and reduce it into the 30s.
I cut down from no more than 50 to no more than 40gm of carbs per day, and a year later my Hba1c was - 42.
Sometimes 'down' is as good as it gets.

 

[Mdub]

Although there are charts giving equivalents, they don't always equate. I got down to a Hba1c of 42 and thought I would eat fewer carbs each day and reduce it into the 30s.
I cut down from no more than 50 to no more than 40gm of carbs per day, and a year later my Hba1c was - 42.
Sometimes 'down' is as good as it gets.

That is interesting and I have heard of such before. Basically your body says, "all things considered this as good as we can get right now." Such unique creatures we all are.

 

[Mdub]

Of course, have you considered that your hba1c may still be reflecting some of those very diabetic levels from September?

In any case, if you are skeptical about the hba1c, you could ask for a fructosamine test, but it might be worth waiting to see what level you get in 3 months time?

Back to your point @EllieM, he said the carry-over from September was highly probable. Case in point, he was willing to wager that if we took the A1c in another month it would in fact show an even lower number.

My primary concern was that the main tool I was using for my levels wasn't accurate enough - like I have been using a screw driver when I needed a torque wrench. He put that to bed for me.

 

[Resurgam]

That is interesting and I have heard of such before. Basically your body says, "all things considered this as good as we can get right now." Such unique creatures we all are.

I suspect that all the decades of my GPs ignoring my descriptions of how I reacted to a high carb low fat diet has something to do with it.
In my late teens when I had free school lunches I developed anaemia and really struggled in the afternoons - physics and games both suffered and that probably changed the rest of my life, now I think about it.

 

[Mdub]

I suspect that all the decades of my GPs ignoring my descriptions of how I reacted to a high carb low fat diet has something to do with it.
In my late teens when I had free school lunches I developed anaemia and really struggled in the afternoons - physics and games both suffered and that probably changed the rest of my life, now I think about it.

I am thankful that as an adult with some resources, I can in fact do my own research and at least try to put some of my very own personal puzzle together. As a child you didn't have any of that and that is unfortunate. My heart goes out to you.

I realized a while back that this is a very specific type of struggle, there is no one size fits all solution for most of us. I am a data junky, I can't even attempt to solve a complex problem without meaningful and comprehensive data. For that reason I have spent the last several months trying to just setup and fine-tune my toolbox. The CGM has been invaluable, I have no idea how I would even attempt do this without that particular device. I guess before those came along folks just had to wing it, which sounds pretty scary honestly. I am sure some of the members here might be able to tell me how that went down.

 

[Mbaker]

Some great points above. I have flogged HbA1c results to death, as I also thought mine were discordant with testing fasting blood glucose, post prandial rises and everything in-between. I tested 6 meters and many Libre CGM sensors. I found that the home test A1cNow + was the closest to what I was expecting at an average of 31.5 after probably a dozen tests (my non-diabetic wife was a 32 as a control).

My latest A1c's are 40 and 38 (the 38 on a Boronate Assay (more suited to my ethnicity)). It doesn't matter for me if my fbg's are 3.8 or 5.x around 5 years ago, or that my post-prandials are low, I had better A1c's with more numbers in the 5's than in the late 3's and 4's. I now just focus on starting number and the rise; it is satisfying that results such as below

correspond with my meter, so I know something weird is up. Strangely my fructosomine results went from 268 to 259 (where lower is better)....but the 259 had an A1c of 2.5 higher than the 268 - at this point, I just scratch my head. I think maybe my red blood cells are just living longer than before or something else. The bottom line is to keep spikes as low as possible.

 

[Mdub]

@Mbaker Dude! What are you DLing in that pic!?! Like 5 Plates??

Either way, nice job. Seems like you have as good a handle on your A1c as is humanely possible. Moreover, pulling that kind of weight off the floor makes me think you have a few things mastered.

I lift, not competing with Eddie Hall by any stretch but, I throw the bells around some. Have you found your lifting changes according to your levels? Do you cardio and if so, how do you prep & post for it?

 

[Mbaker]

@Mbaker Dude! What are you DLing in that pic!?! Like 5 Plates??

Either way, nice job. Seems like you have as good a handle on your A1c as is humanely possible. Moreover, pulling that kind of weight off the floor makes me think you have a few things mastered.

I lift, not competing with Eddie Hall by any stretch but, I throw the bells around some. Have you found your lifting changes according to your levels? Do you cardio and if so, how do you prep & post for it?

Hi @Mdub this was 485 lbs (220 kg) a few weeks ago. Last year I got 500 lbs https://www.diabetes.co.uk/forum/threads/regular-moderate-exercise-log.83995/post-2445181, then got severe Covid a few days later and lost all of my strength and muscle. It has been a long road back, the hardest being rebuilding my lower back muscles.

I continue to evolve my hyper carnivore diet, and will post later tests I have done as an experiment.

The biggest impact on lifting for me is sleep quality.

 

[Mbaker]

Hi @Mdub this was 485 lbs (220 kg) a few weeks ago. Last year I got 500 lbs https://www.diabetes.co.uk/forum/threads/regular-moderate-exercise-log.83995/post-2445181, then got severe Covid a few days later and lost all of my strength and muscle. It has been a long road back, the hardest being rebuilding my lower back muscles.

I continue to evolve my hyper carnivore diet, and will post later tests I have done as an experiment.

The biggest impact on lifting for me is sleep quality.

Correction. I noticed green plates on the end In the avatar picture so that is 440 lbs (200 kg). Here's the real 485 on 22nd Oct:

 

[Mdub]

@Mbaker Either way, it's a respectable lift sir. I have never been much of a DLer, never more than say 350-400 lbs. In my youth, when I was in the military and in decent shape, I was a believer in the big 3: DL, Flat Bench, Squats. I am not a big frame guy, never have been but I did weigh upwards of 220 lbs. (15-16 stone?) at one point and had a near 300 bench (136 kg). We squatted a lot with knee wraps and belts back then so, who knows what that was.

I am lifting right now but nothing like my past. At my age of 53, I work with dumbbells a lot. Over the past probably 8-10 years its been mid level cardio mostly and that has kept the weight off but at the cost of size/muscle mass. Fairly recently diagnosed as a T2 (non-insulin) I am just now trying to juggle my BG with my workout routines. Seems very puzzling honestly. Any advice?

 

[Janecayman]

I just wanted to add that getting your hba1c from 11.3 to 6.4 in only 3 months is absolutely amazing!

Agree very inspiring xxx

 

[Mdub]

Agree very inspiring xxx

@Janecayman @Antje77 Very much appreciated! I am extremely happy with my progress so far, based on feedback it seems very positive. As we all know, when first diagnosed there is a period of shock & dismay, hopelessness even. I am still dealing with that anxiety, learning some coping tricks along the way. I am humbled by the folks I see on this forum and others who have been battling this ailment for decades, my hat is off to all of them. Their stories bring back some hope.

 

[Mbaker]

@Mbaker Either way, it's a respectable lift sir. I have never been much of a DLer, never more than say 350-400 lbs. In my youth, when I was in the military and in decent shape, I was a believer in the big 3: DL, Flat Bench, Squats. I am not a big frame guy, never have been but I did weigh upwards of 220 lbs. (15-16 stone?) at one point and had a near 300 bench (136 kg). We squatted a lot with knee wraps and belts back then so, who knows what that was.

I am lifting right now but nothing like my past. At my age of 53, I work with dumbbells a lot. Over the past probably 8-10 years its been mid level cardio mostly and that has kept the weight off but at the cost of size/muscle mass. Fairly recently diagnosed as a T2 (non-insulin) I am just now trying to juggle my BG with my workout routines. Seems very puzzling honestly. Any advice?

The first thing to say is that I am not an expert, but as with my diet I am honing in on what works for me, much of which is transferable to many. My wife is an expert (ex-PT, Sports Scientist and Physio, so I get my advice from her and watch alot of YouTube). I would describe my best workouts as sub-optimal powerbuilding, as I have learned not to push too hard, but I train hard enough to elicit a response over time and many times twice a day, using auto regulation not a set program. Set modest goals and use restraint not to ego lift e.g. last Thursday I got the 315 bench (3 plates just looks nice), so will use that as my upper limit and do most of my work in the 264 range.

My tips are focus on your main requirement, presumably glucose control, it is better to lift 315 lbs everyday on a 5 x 5, then a 550 dead lift and not be able to walk for a week. I prioritise lifting over cardio... but I do walk after my 2 meals a day, in total up to 7 miles a day, inclusive of walking in between lifting sets, no resting. I try to become as near expert as possible in the technique. I focus on positioning, tension and being as controlled and explosive as possible, and looking for the perfect lift no matter what weight, I love training. I differ from the type of bracing traditionally in the big 3 lifts as I do not expand my tummy out to a belt, I just engage and tense the core in a natural position - this is due to my Karate background, Speed of the warmup sets I find helps as it excites the body ready for the heavier work.

I perform either super or giant sets and full body workouts never wasting a rep and end the session hamstring curls, leg extensions and working my core on the hyper machine, this I find critical to my end game of optimally, building the foundation to warmup (using Karate kicks and punches) perform 5 giant sets and my end of session ancillaries in 30 minutes at high intensity. I have missed out some of what I do, such as a Ketovore diet, pushups in the morning the X3 bar and kick boxing once a week. With your forces background you will do very well. I will stand up my YouTube channel in the new year.