HbA1c Result one month on.

[sshaw99]

Hi All,

Haven't posted for a couple of weeks but have been reading the threads.
I was diagnosed at the end of October as type 2 with an HbA1c of 108.7.
After reading (and generally following!) the great advice on this forum I had my bloods taken again exactly 1 month after being diagnosed (I was diagnosed in hospital in a different county from where my GP is so they wanted to do their own test) and my latest HbA1c is 80.0.
So after 1 month of a change in diet and exercise I've reduced my HbA1c by 28.7 points!
Although still way to go and still get some occasional spikes when trying new foods, I'm really happy with this progress so far in a relatively short space of time!

Will keep you updated on future progress.

 

[douglas99]

Absolutely brilliant!
You need to have a steady progress, so it's an excellent result!

 

[Bluetit1802]

Excellent progress! Well done.

 

[Anne1]

That's fantastic!! Hope I can do as good as you have well done

 

[britincali]

I thought hba1c was only a 3 month test?

 

[Randburg]

Hi,
A HbA1c test measures the average glucose in your Blood over the previous roughly 90 days( this period can be longer in some people) .
Usually HbA1c tests are done quarterly or every 6 months
Ideally, you should have a maximum figure of 53 ( 7% in old terms), but aim for lower 20-42
So you on results you are heading in the right direction. well done
Keep going and let us know how it goes

 

[jack412]

Hi All,

Haven't posted for a couple of weeks but have been reading the threads.
I was diagnosed at the end of October as type 2 with an HbA1c of 108.7.
After reading (and generally following!) the great advice on this forum I had my bloods taken again exactly 1 month after being diagnosed (I was diagnosed in hospital in a different county from where my GP is so they wanted to do their own test) and my latest HbA1c is 80.0.
So after 1 month of a change in diet and exercise I've reduced my HbA1c by 28.7 points!
Although still way to go and still get some occasional spikes when trying new foods, I'm really happy with this progress so far in a relatively short space of time!

Will keep you updated on future progress.

as has been said, it's a test on the cells that have a lifespan of about 3 months...what impresses me more with your numbers are your "Sunday lunch I was 5.4. After 1 hour I was 8.2 and then after 2 hours was 7.6." that is very good for the short amount of time..and your current A1c doesn't reflect it

 

[pavlosn]

Hi,
A HbA1c test measures the average glucose in your Blood over the previous roughly 90 days( this period can be longer in some people) .
Usually HbA1c tests are done quarterly or every 6 months
Ideally, you should have a maximum figure of 53 ( 7% in old terms), but aim for lower 20-42
So you on results you are heading in the right direction. well done
Keep going and let us know how it goes

An hba1c of 20 mmol/mol or 4% is probably way too low for a diabetic to aim for, even if not at risk of medication induced lows.

A very small percentage ( less than 10%) of non diabetics have hba1c below 25 or 4,5% and a recent study has indicated that non diabetics in this range actually face increased mortality rates.

The same study found that the average non diabetic hba1c was 5,3% or 34 mmol/mol

There is also other research that indicates that while the risk of diabetic complications generally decreases with falling hba1c, this risk actually increases once you go below 5,0. Lowest risk estimated at 5,4 - 5,6%

Pavlos

 

[Randburg]

Hi @pavlosn ,
Point taken, I work on the assumption that you should aim for as close to non diabetic results as possible.
In South Africa ( were I am) the Path Labs publish that a HbA1c for non Diabetics is 4-6% (20 - 42), and that for Diabetics a reading of less than 7% ( 53). is the target
I would agree that a reading of 4 (20) is to low,
I aim to be in the non Diabetic range by Going Low Carb, Doing exercise etc., my last reading was 5.4% (36). I do not think I would get it much lower than at present

 

[pavlosn]

Hi @pavlosn ,
Point taken, I work on the assumption that you should aim for as close to non diabetic results as possible.
In South Africa ( were I am) the Path Labs publish that a HbA1c for non Diabetics is 4-6% (20 - 42), and that for Diabetics a reading of less than 7% ( 53). is the target
I would agree that a reading of 4 (20) is to low,
I aim to be in the non Diabetic range by Going Low Carb, Doing exercise etc., my last reading was 5.4% (36). I do not think I would get it much lower than at present

Hi Randburg

A 5,4% is a very good non diabetic score. I would agree with you that trying to keep our glucose levels as typically non diabetic as possible, both in terms of overall hba1c but also in terms of post prandial glucose pattern, would be a sensible approach to take if you are not at risk of hypoglycemia i.e. not on hypo inducing medication.

The risk of hypos seems to also affect what are the generally reported target hba1c levels for diabetics. In the UK 6,5% - 48mmol is the target if not at risk of hypos and 7,5%- 59 mmol if you are, according to the NICE guidelines. Many prefer to have much lower scores trying to stay in the non diabetic range.

But as you state the non diabetic range is a pretty wide range going from 4% to 5,9% percent. So one of the questions that fascinate me is where within that range we should aim to be.

I remember a time, going back to 2009 when I first joined this forum, when gaining admission to the 4 per cent club, going lower than 5,0%, seemed to be a very popular pursuit amongst some forum members, a kind of holy grail chase. Fortunately that does not appear to be the case any longer as I have always had my doubts about the wisdom of such a pursuit.

Regards

Pavlos

 

[jack412]

also its a good idea to give a link to the study you quote from, for people to look at, to at least compare which race group they are in
http://circoutcomes.ahajournals.org/content/3/6/661.long

http://circoutcomes.ahajournals.org/content/3/6/661/T3.expansion.html
the smallest hazzard ratio risk of dying in 8 years seems to be from the groups seems to be 4.0–4.4 @ 0.95 M5 group

Model 5 excludes n=3086 with cancer, CVD, anemia, or hepatitis C.

 

[pavlosn]

Hi Jack

Are you looking at the black line or the bottom of the grey area. I assumed that the line was the important one.

I suspect that the grey area is something to do with the 95% confidence level. Statistics was never my strongpoint.

This is the link to the complete article if anyone is interested

http://m.circoutcomes.ahajournals.org/content/3/6/661.full

Pavlos

 

[jack412]

I must have edited after you posted

http://circoutcomes.ahajournals.org/content/3/6/661/T3.expansion.html
the smallest hazzard ratio risk of dying in 8 years seems to be from the groups seems to be 4.0–4.4 @ 0.95 M5 group

Model 5 excludes n=3086 with cancer, CVD, anemia, or hepatitis C.

 

[pavlosn]

@jack412

In layman's terms, so that I can actually understand, can you please tell me if I am wrong in the way I look at this graph.

I look at the black line as being the significant bid of information.

My understanding is that this represents the best estimate hazard ratio at each Hba1c point and that the grey area shows the 95% confidence level. So that with an hba1c of say 4,5 your hazard ratio could range from approximately 0,7 to approximately 1,8 but most likely estimate aprox steely 1,2.

This appears to indicate a decreased hazard with reducing hba1c all the way to about the 4,6% point and then to indicate increased risk with further reductions.

Between 4,6% and 5,4% the changes in hazard ratio are marginal. Despite the uneven vertical scale the line appears almost straight.

And this is for non diabetics and does not take into account the risk of what a diabetic would have to do in order to reduce his Hba1c from 5,4% to 4,6% whether in terms of additional medication or massively restricted diet.

This German study seems to support the idea that both very high and very low hba1c ( <5%) increase risk in diabetics

http://www.empr.com/both-low-high-hba1c-levels-can-up-mortality-risk/article/385905/

Kind regards

Pavlos

 

[jack412]

the study looked at the chance of being alive in ~ 8 years, it was all races, with all disease, except diabetes [probably not a lot of value given the race differences and diseases shown] so when you take out cancer, CVD, anemia, or hepatitis C. [model 5 group]..the best life expectancy for ~8 yrs was 4-4.5 % A1c ,,, less than HR=1 being 0.95
model 4 and 5 ...this is the group and this is the A1c that had the better chances of being alive factor

 

[pavlosn]

the study looked at the chance of being alive in ~ 8 years, it was all races, with all disease, except diabetes [probably not a lot of value given the race differences and diseases shown] so when you take out cancer, CVD, anemia, or hepatitis C. [model 5 group]..the best life expectancy for ~8 yrs was 4-4.5 % A1c ,,, less than HR=1 being 0.95
this is the group and this is the A1c that had the better chances of being alive

View attachment 8763

Taking those diseases out makes no sense to me, how do you know that there is no causal relationship between CVD for instance and very low Hba1c? Why select just one of the scenarios examined in preference to others.

It is probably just an academic argument as the vast majority of us diabetics would never get anywhere near 4,8 per cent anyway.

For me I am happy being where I am at 5,2% and have no wish to go lower even if for a non diabetic that would marginally represent an improvement in hazard ratio ( which I still harbor my doubts about)

As I said the actions I would have to take to go under the 5% would probably not only reduce my quality of life but actually introduce new risks of their own.

At the end of the day, I consider that anything to do with our treatment of diabetes carries an element of risk with it, the risk of side effects from medication, the risk of adopting a diet that the majority of the medical profession ( rightly or wrongly) does not recommend, the risk of injury from exercise. Balancing this risk against the benefit of controlling our diabetes and reducing the risk of diabetic complications is a matter of personal perception and selection of appropriate methods.

At the moment, pending new evidence, I am happy with the choices I have currently made.

Pavlos

 

[douglas99]

Taking those diseases out makes no sense to me, how do you know that there is no causal relationship between CVD for instance and very low Hba1c? Why select just one of the scenarios examined in preference to others.

It is probably just an academic argument as the vast majority of us diabetics would never get anywhere near 4,8 per cent anyway.

For me I am happy being where I am at 5,2% and have no wish to go lower even if for a non diabetic that would marginally represent an improvement in hazard ratio ( which I still harbor my doubts about)

As I said the actions I would have to take to go under the 5% would probably not only reduce my quality of life but actually introduce new risks of their own.

At the end of the day, I consider that anything to do with our treatment of diabetes carries an element of risk with it, the risk of side effects from medication, the risk of adopting a diet that the majority of the medical profession ( rightly or wrongly) does not recommend, the risk of injury from exercise. Balancing this risk against the benefit of controlling our diabetes and reducing the risk of diabetic complications is a matter of personal perception and selection of appropriate methods.

At the moment, pending new evidence, I am happy with the choices I have currently made.

Pavlos

I would imagine they're taken out, as the text of the report specificity stated they're the main risk associated with CVD, and all the other diseases that lower HbA1C

In context, it's not that the risk of dieing is less, you just don't die from much else.

 

[pavlosn]

I would imagine they're taken out, as the text of the report specificity stated they're the main risk associated with CVD, and all the other disease that lower HbA1C

In context, it's not that the risk of dieing is less, you just don't die from much else.

If I have understood you correctly what the report is saying is very low hba1c is associated with increased deaths from CVD.

So excluding CVD from the hazard analysis artificially presents a picture that makes low hba1c to be safer than it really is, just because the significant risk of death from CVD is excluded from the analysis.

Pavlos

 

[jack412]

ok, just take out hep c. that is group 4,,,.it gives an even lower HR of 0.92 death rate and the best A1c is again 4-4,5

you can be happy wherever you want to be, the problem comes about when you cite a graph that you don't have a handle on and tell people they should have a higher A1c "A 5,4% is a very good non diabetic score." when 4-4.5% have the lowest death rate for 'no hep c' people.

 

[pavlosn]

ok, just take out hep c. that is group 4,,,.it gives an even lower HR of 0.92 death rate and the best A1c is again 4-4,5

you can be happy wherever you want to be, the problem comes about when you cite a graph that you don't have a handle on and tell people they should have a higher A1c "A 5,4% is a very good non diabetic score." when 4-4.5% have the lowest death rate for 'no hep c' people.

Jack

In what universe is a 5,4% not a good non diabetic score for a diabetic to aim for?

The second study I linked to even quotes that as the optimal lowest risk point for diabetics.

Pavlos