Is a low HbA1c dangerous in any way?

[masonap]

Type 2 on insulin (no other diabetic meds) for about 5 years.

I understand that too many Hypos are bad for you, I also know that it is possible to ‘lose hypo awareness’ but my HbA1c is around 33-34 and has been like that for about 3 years, mostly because of a low carb diet, and plenty of exercise. I don’t feel that I’ve had any serious hypos, certainly none that required any help, I very rarely drop below 4 and my average of finger prick tests is about 6 but in the last couple of months (after extreme physical labour which I’m not used to) I have on 4 occasions been between 3.9 and 4.4 and at these levels I know it’s time to eat something.

I’ve recently changed GP practice and having had phone consultations with a nurse, and a doctor, a personal visit to the diabetic nurse at the surgery and another phone consultation they are now insisting that they need to change my meds. I don’t agree so now they want me to have a consultation with the diabetic team at the hospital which I couldn’t stop them from arranging.

The surgery is trying to tell me that my HbA1c is far too low and that it might have other long term health consequences. I’ve tried researching on Google and there is almost nothing about how low the HbA1c can go or the resulting consequences.

Oh, the Dr said my HbA1c was probably lower than his, and he’s not diabetic, but I tried telling him that if I eat any carbs (even with injecting insulin) that my BG levels shoot up (typically still around 8 or 9 just before my next meal time).

Sorry for the long post but does anyone have any experience that might help me?

 

[xfieldok]

Most of us T2's pray for your numbers.

 

[masonap]

Most of us T2's pray for your numbers.

Low carb and exercise did it for me, and I’ve lost a lot of weight too.

 

[Andydragon]

Low carb and exercise did it for me, and I’ve lost a lot of weight too.

why are you still on insulin with levels that well controlled? Isn’t this the opportunity to move to a different regime? The medical center you are saying are talking about different drugs, isn’t this a good thing?

 

[KK123]

Low carb and exercise did it for me, and I’ve lost a lot of weight too.

Hi Mason, you have obviously worked very hard. How is your insulin management, are you on basal and bolus? What would be your normal regime insulin wise? It's a hard one I guess because if they took you off the insulin (have you been on it since the start?), your levels may start to rise or they may not (if you are type 2) and stick to the low carb & exercise approach. My guess is they are worried about you being on insulin and having a lower hb1ac than they would like. It all depends on why you were on insulin in the first place etc.

 

[Bittern]

I suggest you go see your hospital team and discuss the reason for insulin and the proposed change, don't forget to include the effect on you that they expect from the change in medication. You then have the information, possibly with further research, that you need. Also bear in mind that the NICE recommended level of Hb1ac varies in steps as you age. The younger you are the lower the Hba1c. You may have passed one of those trigger points. I am having a warm discussion with my GP because he wants me to run higher than I want to because of these guidelines. I suspect it is to do with life expectancy, the length of time for side effects to increase and perceived competence of the patient, which seems to be age related within NICE, and of course money. Good luck.

 

[Resurgam]

I have read of type twos who went low carb and ended up on no medication - you might be destined for that.

 

[DCUKMod]

Type 2 on insulin (no other diabetic meds) for about 5 years.

I understand that too many Hypos are bad for you, I also know that it is possible to ‘lose hypo awareness’ but my HbA1c is around 33-34 and has been like that for about 3 years, mostly because of a low carb diet, and plenty of exercise. I don’t feel that I’ve had any serious hypos, certainly none that required any help, I very rarely drop below 4 and my average of finger prick tests is about 6 but in the last couple of months (after extreme physical labour which I’m not used to) I have on 4 occasions been between 3.9 and 4.4 and at these levels I know it’s time to eat something.

I’ve recently changed GP practice and having had phone consultations with a nurse, and a doctor, a personal visit to the diabetic nurse at the surgery and another phone consultation they are now insisting that they need to change my meds. I don’t agree so now they want me to have a consultation with the diabetic team at the hospital which I couldn’t stop them from arranging.

The surgery is trying to tell me that my HbA1c is far too low and that it might have other long term health consequences. I’ve tried researching on Google and there is almost nothing about how low the HbA1c can go or the resulting consequences.

Oh, the Dr said my HbA1c was probably lower than his, and he’s not diabetic, but I tried telling him that if I eat any carbs (even with injecting insulin) that my BG levels shoot up (typically still around 8 or 9 just before my next meal time).

Sorry for the long post but does anyone have any experience that might help me?

Masonap, I have read of people living with diabetes being told their A1c is too low. This is because there is usually a concern that the low A1c is leading to, or because of more hypos than could be considered desirable.

If your doctor thinks you will be able to manage without insulin and wants you to try another form of medication, then in my world, I would want to be fully involved in the decision making process, with a plan of how it would be done, and what reviews would be put in place to ensure my own safety and wellbeing.

I know I would certainly be very resistant indeed to a major change in any treatment regime before a holiday period. I would want to know that medics would be available to answer my concerns should any arise. Skeleton staffing doesn't lend itself to that sort of flexibility.

There are many, many treatment options available these days, without insulin involvement, so there could be something there, BUT, I know if I were in your shoes, I'd be trying to keep an open mind to listen to the options put before me, but then taking my time to go away, think about it and do my own research.

Good luck with it all, and let us know what transpires.

 

[NicoleC1971]

I have a type 1 friend who likes to keep her sugars very low and did ask about the risks of low blood sugars. She is type 1 so not as low as you! I also asked the same question having noticed that with low carb my hypo tolerance level went lower (i.e. I was technically hypo but did not feel it ). That time I was warned about losing hypo awareness thus it was a safety concern for anyone using exogenous insulin. My friend was told that she risked brain damage with consistently low sugars which makes intuitive sense if the brain is a glucose hungry organ but if you are doing low carb then you may have a great supply of ketones feeding your brain too!

As others have pointed out it would seem you have become sensitive to your own insulin again and therefore may not need to inject so much but I am assuming that you are in discussion about this issue bearing in mind that the nurse may have less experience of a type 2 needing less insulin than of type 2 needing more and more of the stuff.

 

[masonap]

why are you still on insulin with levels that well controlled? Isn’t this the opportunity to move to a different regime? The medical center you are saying are talking about different drugs, isn’t this a good thing?

I only inject insulin, I don't take metformin or anything else. If I eat more than a few carbs my BG levels shoot up, and that's with insulin! I guess if I eat no carbs then maybe I can come off the insulin, but no carbs is difficult, and I suspect not a wise move.

 

[masonap]

Hi Mason, you have obviously worked very hard. How is your insulin management, are you on basal and bolus? What would be your normal regime insulin wise? It's a hard one I guess because if they took you off the insulin (have you been on it since the start?), your levels may start to rise or they may not (if you are type 2) and stick to the low carb & exercise approach. My guess is they are worried about you being on insulin and having a lower hb1ac than they would like. It all depends on why you were on insulin in the first place etc.

I was put on insulin because my levels kept on rising. I take Humalog before meals, 2 units at breakfast, 4 at lunch and dinner, then 14 units of Abasaglar at bedtime. I feel this is as close to perfect as I can be, and I don't take metformin or anything else.

 

[Andydragon]

I only inject insulin, I don't take metformin or anything else. If I eat more than a few carbs my BG levels shoot up, and that's with insulin! I guess if I eat no carbs then maybe I can come off the insulin, but no carbs is difficult, and I suspect not a wise move.

I understand, sounds like you are in a challenged position where your good work at lowering your levels is making the medical people inclined to take you off your meds
I’m not sure what happens if they decide that you shouldn’t have it anymore, fingers crossed for you!

 

[bulkbiker]

I suspect not a wise move.

Plenty of people have found otherwise.. and come off insulin for T2 ..

But out of interest have you ever had a c-peptide test?

 

[masonap]

Plenty of people have found otherwise.. and come off insulin for T2 ..

But out of interest have you ever had a c-peptide test?

No to the c-peptide test.

 

[Lamont D]

I have a type 1 friend who likes to keep her sugars very low and did ask about the risks of low blood sugars. She is type 1 so not as low as you! I also asked the same question having noticed that with low carb my hypo tolerance level went lower (i.e. I was technically hypo but did not feel it ). My friend was told that she risked brain damage with consistently low sugars which makes intuitive sense if the brain is a glucose hungry organ but if you are doing low carb then you may have a great supply of ketones feeding your brain too!

I had a discussion with my endocrinologist about having continuous low blood glucose levels and he said that it was dangerous because of the brains need to have a constant stream of glucose to give you normal brain function.
I suffered a lot of hypos before diagnosis. Every day for years and due to the hypos I don't remember much from then, I have no idea how many times I blanked out, once in a shop, many times relaxing at home and for some reason I always 'woke up' these lasted sometimes for a couple of hours or I was woken up most times unaware of what happened. I thought at the time it was the symptoms I was getting like lethargy, sleep deprivation, brain fog and memory loss.
Obviously, I was unaware of what was happening to me, it wasn't until I started recording my levels did I even know what a hypo was. This was the reason I was continually going back to my GP.
My endocrinologist insisted I should ensure that I was always above normal levels and recommended eating ' healthy low GI foods' every three hours to offset the hypoglycaemic episodes.
So after a while I found out that RH, is a food orientated condition. I started going very low carb and I stopped going hypo. With the benefits of having quite a few eOGTTs and my own experience, I came to a conclusion that for some reason my brain does not need a lot of glucose to have normal brain function. This is because I have spent most of the time since diagnosis in ketosis. I also believe that having your blood glucose in normal levels continually is the best way to get healthy. My body really likes it there and my brain is working fine. Fluctuating blood glucose levels is bad for you!
When I told my endocrinologist that I was in Keto, and gave him my food diary to peruse, which showed that I hadn't had a hypoglycaemic episode for about three weeks, he asked how I was and my energy levels.
I had never felt as good as I was for a very long time. And I was losing weight.

Yes, your brain does need glucose but I believe that if you're in control and you are aware that the food you eat doesn't have a detrimental effect. The brain will look after itself.

 

[JAT1]

Type 2 on insulin (no other diabetic meds) for about 5 years.

I understand that too many Hypos are bad for you, I also know that it is possible to ‘lose hypo awareness’ but my HbA1c is around 33-34 and has been like that for about 3 years, mostly because of a low carb diet, and plenty of exercise. I don’t feel that I’ve had any serious hypos, certainly none that required any help, I very rarely drop below 4 and my average of finger prick tests is about 6 but in the last couple of months (after extreme physical labour which I’m not used to) I have on 4 occasions been between 3.9 and 4.4 and at these levels I know it’s time to eat something.

I’ve recently changed GP practice and having had phone consultations with a nurse, and a doctor, a personal visit to the diabetic nurse at the surgery and another phone consultation they are now insisting that they need to change my meds. I don’t agree so now they want me to have a consultation with the diabetic team at the hospital which I couldn’t stop them from arranging.

The surgery is trying to tell me that my HbA1c is far too low and that it might have other long term health consequences. I’ve tried researching on Google and there is almost nothing about how low the HbA1c can go or the resulting consequences.

Oh, the Dr said my HbA1c was probably lower than his, and he’s not diabetic, but I tried telling him that if I eat any carbs (even with injecting insulin) that my BG levels shoot up (typically still around 8 or 9 just before my next meal time).

Sorry for the long post but does anyone have any experience that might help me?

I also have low Hba1c, so low, that the endo couldn't give me a number and just said that it was below their measurable scale. Later it went up to 4.5 or thereabouts. She had never seen one so low and was concerned. However my blood prick tests were always above 4. Turned out it was because I'm very anemic. Since I found that out I started eating liver every day and since covid set in I haven't had any more blood tests. I'm pretty sure my anemia is over, or at least much better, because of the colour in my cheeks. If you follow the low-carb approach, an Hba1c of less than 5 is considered a very good thing.

 

[mansingh01]

Type 2 on insulin (no other diabetic meds) for about 5 years.

I understand that too many Hypos are bad for you, I also know that it is possible to ‘lose hypo awareness’ but my HbA1c is around 33-34 and has been like that for about 3 years, mostly because of a low carb diet, and plenty of exercise. I don’t feel that I’ve had any serious hypos, certainly none that required any help, I very rarely drop below 4 and my average of finger prick tests is about 6 but in the last couple of months (after extreme physical labour which I’m not used to) I have on 4 occasions been between 3.9 and 4.4 and at these levels I know it’s time to eat something.

I’ve recently changed GP practice and having had phone consultations with a nurse, and a doctor, a personal visit to the diabetic nurse at the surgery and another phone consultation they are now insisting that they need to change my meds. I don’t agree so now they want me to have a consultation with the diabetic team at the hospital which I couldn’t stop them from arranging.

The surgery is trying to tell me that my HbA1c is far too low and that it might have other long term health consequences. I’ve tried researching on Google and there is almost nothing about how low the HbA1c can go or the resulting consequences.

Oh, the Dr said my HbA1c was probably lower than his, and he’s not diabetic, but I tried telling him that if I eat any carbs (even with injecting insulin) that my BG levels shoot up (typically still around 8 or 9 just before my next meal time).

Sorry for the long post but does anyone have any experience that might help me?

Hi, those numbers ok - dr Bernstein a diabetic doctor in the USA recommend 4.5. The more higher it is the more chances of damage to body. By the way what is your insulin regime and what Types is it?

 

[masonap]

Hi, those numbers ok - dr Bernstein a diabetic doctor in the USA recommend 4.5. The more higher it is the more chances of damage to body. By the way what is your insulin regime and what Types is it?

I’m type 2, I use Humalog during the day, 2 units before breakfast and 4 units before lunch and dinner (I have a chart to follow so if my BG levels are up I can inject more insulin but I haven’t done that for over a year) at night I use Abasaglar 14 units before bed. My HbA1c reading of 34 translates into 5.3% and I’m very happy with that and don’t understand why my Dr surgery thinks it is too low. So far I don’t have a reason to feel that it needs to be higher.

 

[Tophat1900]

I'd be wanting a c-peptide test if in your shoes. And go from there. If it's high, then injecting more is generally not a great idea So you could then discuss with your team the possibility of different medications if you wanted to. Your A1c is not too low, and it just sounds like they are using fear tactics to try and get you to eat more carbs and increase it. The doctor comparing his own to yours is a ridiculous comparison. If you are not having a lot of hypos (apparently you are not) then there is no reason to raise it that I can see. I've been told mine is too low (They just assumed I was hypoing all over the place) and I was not. You'd at least think they would ask if I was hypoing and how much so, but nope... lol

 

[EllieM]

As a T1, if I get too many hypos I start to lose hypo awareness, so the doctors start complaining once my hba1c goes much below 50. On the other hand, as I'm now self funding a dexcom, I've been able to avoid a whole lot of hypos by having an alarm set at 4.4, and I feel free to try for lower....

But T2s typically start out by making massive quantities of internal insulin, and progress to insulin injections because either their insulin resistance goes up to the point where their internal supply isn't enough, or because their insulin producing cells have been worn out by the over production of insulin, or some combination of the two. If @masonap is still producing lots of insulin then coming off injections (those seem like quite small doses for a typical T2, though I realise that everyone is different) might well work.

But if his insulin production is now low, insulin is going to remain his best friend. He needs that cpeptide test.

And one other possibility that you may not have thought of. The original T2 diagnosis may have been a missed LADA/T1 one. Many doctors don't bother to do the differential T1/T2 test and just assume T2 for older and/or fatter patients.

Good luck.