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How low is too low for an HbA1c?

Discussion in 'Type 2 Diabetes' started by wellwell1212, Sep 20, 2011.

  1. wellwell1212

    wellwell1212 Active Member

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    How low is too low for an HbA1c? Many of us try hard to get our HbA1c close to 7% as research has consistently shown that diabetic complications are generally reduced with tighter blood glucose control.
    However, there has been discussion whether HbA1c targets under 7% could be too low as a target.


    Read this above tonight and thought you beauty if its for real :) I broke the 8 barrier on my last test (8.1) but, was in the 7's previously and I had been a bad boy the past while :( Anyway, what I would like to know is, what is an acceptable range for HbA1c ? Given the above info, is 7 to 7.5 good or is up to 8 not the end of the world ?
  2. wiflib

    wiflib Active Member

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    I have type two. If my HbA1c was in the 6's I would be horrified. My last one was 5.1 mainly because I don't have wild swings between high and low BS.

    I would be very happy with an HbA1c in the high fours.

    wiflib
  3. borofergie

    borofergie Well-Known Member

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    It depends what medication you're on.

    If you're on diet only, or metformin, then the risk of hypos is low, so you can go as low you can. Some people here get beneath 5% without any complications.

    The risk of hypos is much higher with insulin, so some people choose a higher HbA1c target. However, there are also some carefully controlled T1s here who are life members of the 5% club.

    The truth is that only you can decide what your ideal target is. You need to weigh up the potential consequences of your HbA1c level against the level of sacrafice you are willing to make.

    My own philosophy is that I can't accurately calculate the consequences of a high HbA1c, so I choose to minimise the risk of complications by minimising my BG whenever possible (by low carbing and running). Other people decide that risk of complications is low when your HbA1c is 7%ish and so legitimately decide to eat a more fun diet. (Others still would like a lower HbA1c but their broken pancreas won't let them get any lower).

    A HbA1c of 8% is equivalent to an average BG of 10mmol/l.

    The NICE Guidelines for T2s (which some people think aren't conservative enough) suggest that your BG should be
    * Before meals: 4-7mmol/l
    * Two hours after meals: less than 8.5mmol/l
    so 10mmol/l on average does seem kind of high.
  4. borofergie

    borofergie Well-Known Member

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    +1

    This is almost exactly my situation. I'm at 5.2%. I'm sure that I could get into the 4s, but like I said above, I'm not sure that the effort involved would be worth the reduction in risk.
  5. Sarah69

    Sarah69 Active Member

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    My last 1 was 7.8 and my dsn was happy with that.
  6. wiflib

    wiflib Active Member

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    That's great Sarah. Are you happy with it?

    wiflib
  7. Sarah69

    Sarah69 Active Member

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    Very happy because before that it had never been in single figures!
  8. clearviews

    clearviews Active Member

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    My aim is to have as close to a non-diabetic A1c as I can possibly get. If I need meds to achieve that then I will but for now VLC works for me. If I get into the 4s I would be very comfortable with that too.
  9. Grazer

    Grazer Well-Known Member

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    I think Borofergie got it right here. It's a matter of choice Vs sacrifice, but also of ability to achieve certain levels for certain people. I think we should be careful of saying we think HbA1c's in the order of 7 or so are too high, and effectively "knocking" them, because for some people that may represent a mammoth effort and achievement.
  10. markd

    markd Active Member

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    If not on insulin or insulin-forcing drugs I don't think there is a 'too low' since it is extremely unusual to get a dangerous hypo.

    My A1c drifts between 4.6 (which seems to be the usually stated minimum of 'normal') and 5.2.

    I'm happiest when I keep it below 5 as that is the range for the majority of non-diabetics and it seems only sensible to minimise the risks of complications.

    If you are on insulin, sulphonylureas or similar, then the dangers of a hypo would be a major determinant of what your target should be.

    I suspect it also depends on how hypo-aware you are, I hit BGs of 3.6 and 3.7 occasionally and apart from feeling mildly fatigued, can't say I really notice, so I'd be at greater risk if I was on insulin and tried to keep a really low A1c.

    If you are very sensitive to hypos, you probably have plenty of time (when awake) to grab some candy to reverse a hypo - but I have no experience of this, so take it as no more than a guess!

    mark
  11. tighthead3

    tighthead3 Member

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    had my annual check today and HbA1c was 6.0, cholesterol 4.1, DN saisthese were well within safe limits, cant understand it when some people come on here and say these kind of figures are too high, surely its down to the individual to live their lives how they deem it with regards to their diabetes, as a type 2 I would really have to struggle to get below 5 as I exercise 3/4 times a week , watch what I eat and rarely drink alcohol, a lot of people who post on here seem quite confused about the often misleading information we get bombarded with, my view is if you, the individual feel ok then be happy.
  12. littlemolly

    littlemolly Member

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    my latest HbA1c was 6.5 and as a pump using type 1 I was delighted! I really wouldn't want it any lower and my DSN thought it was great. Last year I suffered from constant hypo's and was often found unconcious during the night - yes my HbA1c dropped, but not healthily! I have been diabetic for 30 years, had HbA1c's of around 10 for a lot of that time and touch wood have not had any complications. Since having a pump those levels have dropped dramatically. It's not all about how low you can get!
  13. Caleb Murdock

    Caleb Murdock Member

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    I have to disagree with some of the posters who have made it sound like it's okay to have an A1c of 7 or more. Studies have shown that you can develop diabetic complications with an A1c of 7. Personally, I think we should all be aiming for an A1c that is low enough to avoid any complications (which, in my judgement, is probably in the vicinity of 5.5). I'm not suggesting that anyone feel ashamed of having a high A1c -- shame or embarrassment does us no good. But don't be satisfied with an A1c at a level that could harm you.

    I don't know what "dsn" stands for, but an A1c of 7.8 is not one that any doctor should be happy with. That is quite high.
  14. viviennem

    viviennem Well-Known Member

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    DSN is 'diabetic specialist nurse', Caleb.

    Viv 8)
  15. markd

    markd Active Member

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    I agree absolutely, I cannot see why any T2 would settle for an A1C higher than the normal range, without good cause (being a T1 and/or on insulin or other drugs that can cause a hypo being a good cause, I think.)

    Many authorities reckon the normal range runs between 4.6 and 6.0 (though I think Bernstein goes lower still) and bearing in mind there is a straight-line increase in cardiac risk as A1c goes up, it only makes sense to stay as low as possible,

    Bloodsugar101 has a lot of info - http://www.phlaunt.com/diabetes/15945839.php - and says, in brief:

    1) If your A1c is between 4.8% and 5.4% your risk is beginning to rise.

    2)If your A1c is between 5.4% and 6.0% your cardiac risk is becoming significant.

    mark
  16. Caleb Murdock

    Caleb Murdock Member

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    Well, now, let me backtrack just a smidgen. I encourage people to get their A1c's as low as possible, but if we have to get down to 4.7 in order to stop any damage to our bodies, that may be an unattainable task for a lot of us (like me). I just got an A1c of 6.0; and although I'm happy with it, I'm shooting for a 5.5. But will I ever get to 4.7? I don't think so. I'm one of those carbohydrate addicts who can't stop eating what he shouldn't eat. (I found that out today, for the hundredth time, when I went off my diet.) I got my 6.0 by covering my dietary slips with insulin injections, but I've pretty much given up the hope of really getting my carbs low.

    I love Jenny Ruhl. In fact, she was the one who turned me on to regular insulin, on which I'm having great success. But she also tends to see things from a somewhat negative perspective. If there is one piece of research that suggests that an A1c over 4.7 might be harmful, it becomes part of her gospel. Like Bernstein, she encourages people to be perfect. But perfection just isn't in the cards for most diabetics.

    However, I think that both of us can agree that an A1c of 7.8 is beyond the pale.
  17. Grazer

    Grazer Well-Known Member

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    Whereas I agree that as low to normal an HbA1c as possible is desirable, I think we should be wary of alarming people who can't get down to some of the figures quoted. We also need to consider some of these statements about "significant risk". The risk figures used are the same as those used by Prof Christiansen at the Copenhagen summit. He used a risk factor of 1.24 for people with an HbA1c between 5.5 and 6.0. What this means is that if a non-diabetic had a 10% risk of CVD from their normal lifestyle/situation, then a raised A1c to this level would increase their risk to 12.4%. Nowhere near as significant an increase as being mildly overweight, or lacking fitness. %'s of %'s can be made to sound alarming or not, it's a matter of how you display them.
    The same study showed that as we age, our HbA1c increases anyway, and that 6.0 can be normal for a male of 60!
  18. Unbeliever

    Unbeliever Well-Known Member

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    I understand that many studies suggest that oo intense contro measured by HBA1C is acually harmful to children and the elderly.

    I wonder what the definition of the latter group might be? As someone who has suffered complications due to a too rapid lowering of my blood sugar levels I am convinced hat personal targets are he way to go.

    While here has o be some sort f uidance and benchmarks there is an obsession with figures - not in order
    to benefit the patient but for NHS admin purposes. I wonder how much harm his has caused?

    After all these targes and the levels at which diagnosis of diabetes is made are not set in sone..
    They have changed in the pas and will no doubt do so again in he future,

    This may be because of increased scienific knowledge abut is just as likely o be for economic and political purposes.. It is impossible to seperate these hings.

    The HBA1 C is a tool and probably the best available at present. It is not infallible or the last word.
    Unfortunately as more and more Gps choose[]or are forced to leave treatment of diabetes to nurses it becomes the goal of treating the patient as an individual r becomes less attainable.
  19. Sid Bonkers

    Sid Bonkers Well-Known Member

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    IMHO the above statement is absolute garbage and the fact that these days on this forum rubbish like this is posted so often now is the reason I do not post much any more.

    You should be ashamed of yourself for posting stuff like this that just scares the hell out of people who are newly diagnosed and dont know any better.

    Thankfully when I was newly diagnosed there were a lot of very knowledgeable members here who would offer good solid advice rather than just trying to scare people into low carbing with comments like those above.

    If you have reduced your bg levels then be very proud of yourselves and whatever you do dont be upset by garbage like this "If your A1c is between 5.4% and 6.0% your cardiac risk is becoming significant". Becoming significant? What does that even mean? :lol:
  20. Grazer

    Grazer Well-Known Member

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