HbA1c - can it be too low?

[barrym]

Hi

Just had my latest test results since going onto bolus injections, and they are a lot lower than last time. Back in September I was 60 in new money, right at the top of the acceptable range, but today it's 41

I spoke with my DN , and she said it was too low! Try to get it at 52. Any lower and you may lose your sensitivity to hypos. I thought I was doing so well too

 

[AMBrennan]

You lose your sensitivity to hypos if you frequently have low blood sugar; if you manage an HbA1c of 40 without having hypos then there is no reason to be concerned about hypo sensitivity.

 

[Daibell]

Hm. An HBa1C of 52 as a target sounds too high to me? I tend to run my fasting sugar between 4 & 5 mmol which could mean I'm also at risk of not recognising a hypo, but I've read various views on the subject of hypo sensitivity and they are a bit inconsistent so I will continue to go for a low'ish HBA1C like you. I guess it's your choice as long as you are aware of the trade-offs.

 

[ElyDave]

I was told the same when my last one came it at 40, down from 46. To be honest I'd rather run the risk of mild hypos than the long term complications.

I'm in the opposite region at the moment. Where I'd prefer to be operating around 4.5-5.5, I'm currently drifting up towards the 6.5-7 region due to a cold.

 

[noblehead]

Barry, as long as you still have good strong hypo awareness symptoms and hypo's are not a daily occurrence then I wouldn't worry about it too much. What your dsn is saying that those who do run their bg too tight can have diminished hypo awareness symptoms and this is properly what they are concerned about, 41 is good control but personally I wouldn't want to go much lower than that .......but that is entirely your call based on your own experiences.

Well done btw!!!!!!!

 

[jopar]

I was told the same when my last one came it at 40, down from 46. To be honest I'd rather run the risk of mild hypos than the long term complications.

I'm in the opposite region at the moment. Where I'd prefer to be operating around 4.5-5.5, I'm currently drifting up towards the 6.5-7 region due to a cold.

I hope you don't drive!

Hypo unawareness is just as dangerous and just as disabling as other long term complications....

Don't forget that the more hypo's you have the more desensitised the body becomes to them, this then limits the window for instigating treatment to avoid a medical emergency. If you lose your ability totally to pick up a hypo then you are totally reliant on a 3rd party to react very very quickly and instigate treatment as you are already in a medical emergency and dire straits...

Barry

The range that the medic's set is a point where you're avoid disabling hypo's and have a low risk of long term complications... These figures aren't pulled out of an hat, but is something that is constantly reviewed via the comparison of all Hba1c results collected, plotted ans reviewed... What you need to do is download your meter readings into the software and have a look at the ranges your are getting that make this result, check out if and how many hypo's you are having, When are you picking them up the earlier the better your awareness is...

If you having hypo's even if they are just below the 4mmol/l mark, take a look at your control to see if you can do something to prevent them, see where you go from there..

 

[AlexMBrennan]

By the same logic you shouldn't drive with a BG of 10 mmol/l because 20 mmol/l is further away from a hypo - what matters is if you get hypos with your current target levels; if you don't get hypos then there is no inherent reason to be concerned about hypos just because BG could be higher.

4.5-5.5 mmol/l is NOT a hypo.

What you need to do is download your meter readings into the software and have a look at the ranges your are getting that make this result, check out if and how many hypo's you are having

And how is this software going to divine hypos not detected by actual blood tests (which wouldn't require fancy software to notice)?

 

[ElyDave]

I hope you don't drive!

Hypo unawareness is just as dangerous and just as disabling as other long term complications....

Don't forget that the more hypo's you have the more desensitised the body becomes to them, this then limits the window for instigating treatment to avoid a medical emergency. If you lose your ability totally to pick up a hypo then you are totally reliant on a 3rd party to react very very quickly and instigate treatment as you are already in a medical emergency and dire straits...

Barry

The range that the medic's set is a point where you're avoid disabling hypo's and have a low risk of long term complications... These figures aren't pulled out of an hat, but is something that is constantly reviewed via the comparison of all Hba1c results collected, plotted ans reviewed... What you need to do is download your meter readings into the software and have a look at the ranges your are getting that make this result, check out if and how many hypo's you are having, When are you picking them up the earlier the better your awareness is...

If you having hypo's even if they are just below the 4mmol/l mark, take a look at your control to see if you can do something to prevent them, see where you go from there..

********.
I don't have hypo unawareness and 4.5-5.5 is not a hypo. <3.5 is a hypo, I'm far enough away from that. And please point out to me where I've said I don't adjust my levels to drive.

I have pretty good hypo awareness and have symptoms starting around 4 or even higher. I'm prepared to take the risk of occasional mild hypos rather than risk long term complications. I track my readings very carefully and so far I have <1% of my readings below 3.5.

If you want to start telling me I'm not safe to drive, get some evidence first, you are clearly providing an opinion here without asking any questions first

 

[jopar]

There is no need for foul language!

At what point did I say 4.5mmol/l was a hypo? I didn't

Actually the clinical definition of hypo's is <3.7 mmol/l the point where the brains ability to function correctly starts to be impaired.. But that's not either here or there for driving purposes, as the Law states that you have to be 4mmol/l or above for driving, anything below this figure you are consider to be driving under the influence drugs or alcohol...

But going back to the wisdom behind '

[To be honest I'd rather run the risk of mild hypos than the long term complications./QUOTE]

From what you said experience tells me, that it's a high probability that you have an blasé attitude towards mild hypo's, that they don't do any damage over a period of time. Which if you drive could indicate you may totally ignore that even a compromised hypo awareness is pretty dangerous when driving, as you are at a lot higher risk of not picking up an hypo while driving in time to pull over safely to treat...

I also see from your signature that you've not long been diagnosed with diabetes, so may not realise that mild hypo's are to be taken seriously as the more frequency and time your body is in the mild hypo state the quicker your hypo awareness will be compromised, when I say compromised it means, that even though your are able to pick a lot up in the top end of the 3's, the frequency that you aren't picking them up until your are mid 3 or lower increases, which then means you are restricting the window you have to self treat before you need 3rd party intervention from a prompt or via the paramedic...

Oh, I've been diabetic for 25 years, and my hypo awareness is still fully intact I pick them up around about the 3.8/9 mmol/l mark, the only time I may go lower than this, is if I have several in a short space of time, then it's probably the mid 3's that I start to pick them up. Hence why I avoid mild hypo's as much as possible... I do have a tight range of control and my HbA1c is in the 5% range,

My husband who's had diabetes now for 35 years, attitude towards mild hypo's is a bit like yours, has never seen them as much of a problem, he does now have a compromised hypo awareness, which means normally he won't pick a hypo up until he hits the mid 3's, which in reality gives him very little time to self treat, before he requires 3rd party help to bail him out..

 

[DonnaC-T]

It's 5 to drive now not 4, anymore. My dsn told me a month or two ago. X

 

[paul-1976]

It's 5 to drive now not 4, anymore. My dsn told me a month or two ago. X

I was told the same and if below 5-to eat a snack.

 

[jopar]

Since blood glucose testing became standard practice, the DVLA advice has always been to test before driving

If your BG is between 4-5mmol/l then have a snack or a meal before you drive.

If above 5mmol/l then if you haven't eaten prior to setting out, again have a snack to ensure that bg's don't drop.

It's not actually illegal to drive with a blood glucose level between 4-5mmol/l just unwise due to the possibility that doing so would put you below the legal limit which is a blood glucose reading of below 4mmol/l.before you reach your destination

 

[JRW]

My last was 41 and I was told it was too low. I'm relatively new to diabetes so I don't know what the real risk is of running at 6-8 vs 5-6. All that I know is that I can't run at 4-6 if I'm to lead a normalish life, I do quite a lot of exercise which makes my BG quite unpredictable. Is slighty lower better with hypos + less exercise?

 

[ElyDave]

My last was 41 and I was told it was too low. I'm relatively new to diabetes so I don't know what the real risk is of running at 6-8 vs 5-6. All that I know is that I can't run at 4-6 if I'm to lead a normalish life, I do quite a lot of exercise which makes my BG quite unpredictable. Is slighty lower better with hypos + less exercise?

There is absolutely no reason to restrict your exercise as a diabetic, you just need to learn ho to manage it in that scenario.

Personally through trial and error i've learned what insulin dose reductions I need and what carb intake I need for anything from a quick 8km run through to 100km on the bike.

Overall, more exercise will give you better insulin sensitivity and can help achieve better control. I'm in the same position as you in that I'm reasonably newly diagnosed and still likely to be producing some insulin of my own, which can make things a bit trickier.

A good starting point would be to make sure you are above 6.5 when you start exercising, take some carbs with you, test again every half hour and add carbs as necessary. to avpid complication fro now, you might want to wait until any quick acting insulin is out of your system, say 4 hours after a meal, just to avoid the added complication of dose adjustments. You'll soon work out a database of effect vs exercise.

 

[jopar]

JRW

Remember Diabetes live with you, you don't live with it...

This site will give you a lot of information about training and taking control of your blood glucose levels http://www.runsweet.com/

Different types of exercise has different effects, and can have varying time lags when it ever starts hitting the levels or carries on hitting the levels, so need to be aware of this.

I know with exercising my dogs, that a training session with them needs a lot more glucose or should I say a lot less insulin than a general walk/exercise...

If you aren't resolving the hypos/exercise then perhaps a insulin pump would be an better option, you might have to fight for it though, I know I battled for 3.5 years to get my insulin pump, but it is so much more flexible when it comes to control.