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Great HbA1c result but got told off for it...

bulkbiker said:
Sure divide trigs number by HDL result . You want the answer to be be 0.87 or lower.
There's a long and involved explanation about the benefits of triglyceride levels being low and HDL being high and it can be used as a proxy for "better" cholesterol levels. Do you want me to dig out some bits on it for you?
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Hi @bulkbiker According to Prof Sikaris, the TC/HDL ratio is a better marker of triglycerides than the measured triglyceride value itself, which is very variable. It is also the ratio that heart consultants are fond of (by chance). So that is what I favour when looking at my own results. The OP's value of 1.5 is pretty amazing as below 3.5 is the target.
 
BrianTheElder said:
Hi @bulkbiker According to Prof Sikaris, the TC/HDL ratio is a better marker of triglycerides than the measured triglyceride value itself, which is very variable. It is also the ratio that heart consultants are fond of (by chance). So that is what I favour when looking at my own results. The OP's value of 1.5 is pretty amazing as below 3.5 is the target.
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Thanks for that...will start looking at that one too.
 
BrianTheElder said:
Hi @bulkbiker According to Prof Sikaris, the TC/HDL ratio is a better marker of triglycerides than the measured triglyceride value itself, which is very variable. It is also the ratio that heart consultants are fond of (by chance). So that is what I favour when looking at my own results. The OP's value of 1.5 is pretty amazing as below 3.5 is the target.
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So when I get the “statin conversation” I shall mention that! Thank you :)
 
Mel dCP said:
So when I get the “statin conversation” I shall mention that! Thank you :)
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I would check those figures first. I have a sneaking feeling it is your HDL that is wrongly quoted. 4.2 is very high. The standard range is around 1.2 to 3.5 .
 
dbr10 said:
Seems to be a theme here. You've got things moving in the right direction. Brilliant. So why the obsession with 50?
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It whats the data shows gives the best long term outcomes, but the data did not include poeple with CGMs and very few poeple know about keto diets.

Nurses are mostly trained to do what they are told by the experts without understanding why they have to do it. Doctors had a few years training in science when they were expected to think about the why.
 
Mel dCP said:
:mad: Rant alert :mad:

I had a raft of blood tests last Friday to investigate why I’ve been getting blood pressure drops when I stand up, and the nurse asked if I’d like her to take an HbA1c while she was at it - I jumped at it because my last one covered one month of no Libre and lots of carbs (and Christmas) plus two with Libre and keto, so didn’t really give me an accurate picture of how things have improved since I got it.

Phone rang this afternoon, it was the practice nurse. She just said that they’d got my results and my HbA1c was 43. And then silence. I assumed it was to give me time to gush, and I said how thrilled I was with such a good result. More silence.

They want me to drop my insulin and get it back up to 50.

I said no way, that 43 comes under “excellent control” on the chart they have on their wall, and that I was delighted. Cue a lecture about hypos, and I tried to explain that I don’t really have any, maybe one mild one a week (never at night), and that I never drop below 3mmol. She actually said she didn’t believe me! And wants me to come in so I can have hypos explained to me. I explained that having had T1 for 20 years, I was very experienced at having hypos, but I’m now managing it in such a way with my Libre as to make sure I don’t get them, and explained the “sugar surfing” methods of a glucose tab here, half a unit there to nudge my sugars into range if they’re drifting off. Apparently I must be having night hypos! I’m going to have to go in armed with printouts of my Libre traces to prove that I’m not - I haven’t had a night hypo since flippin’ January! We had the driving conversation and I explained that I run my sugars a little higher (6-7mmol) to drive, and she said I should be aiming for TEN :mad:

So that’s rather taken the shine off a result I’ve been working so hard to accomplish.

:banghead::banghead::banghead:

I also got cholesterol numbers, but I’m not quite sure how to interpret them, can the hive mind help? She didn’t seem too happy about those either.

Total 6.2; HDL 4.2; LDL 3.7; Trigs 1.2

Anyway, I’m seeing my GP at the end of the month to discuss it all, looks like I’ll have to go armed with my lever arch file of results and dig out the battle handbag again :)

/rant
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well done mel :joyful:
 
Stupid question.

Who defines what's "good."

One of the things I have found out since last september is that really nobody seems to have any idea how diabetes works... there is so much randomness that you can make anything you could say seem right. It's like horoscopes, if you make it totally generic anyone can make it fit their own life. On top of that, you have the fact that some (most) medical people say things that are simply wrong which is just... weird. In the end it is hard to know even what to aim for. There is a green bar on the libre display, who says where that is supposed to go?
 
NoKindOfSusie said:
Stupid question.

Who defines what's "good."

One of the things I have found out since last september is that really nobody seems to have any idea how diabetes works... there is so much randomness that you can make anything you could say seem right. It's like horoscopes, if you make it totally generic anyone can make it fit their own life. On top of that, you have the fact that some (most) medical people say things that are simply wrong which is just... weird. In the end it is hard to know even what to aim for. There is a green bar on the libre display, who says where that is supposed to go?
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I set the target range on the Libre to where I want it, it’s at 4.5-7.5 :)
 
Bluetit1802 said:
There is something wrong with those figures.

The Total cholesterol is made up of LDL + HDL + 46% of the trigs
Your figures don't add up.

4.2 + 3.7 = 7.9 all on its own, without adding in the 46% of trigs.

I suggest you check the numbers on-line or on a print out.

I have seen many other threads on here where T1s have been told off for low HbA1cs. They seem paranoid about hypos. Your 43 (excellent by the way) equates to an average of 7.1mmol/l. I can see nothing wrong with that. I would try to put what she said out of your head - and next time you see her do take along your Libre prints.

All I can say is well done and congratulations. :)
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I got the same from my HCP yesterday for an HbA1c of 42, so it is not unique to either of us. I think what is behind it was a study released last year that showed that diabetics on tight bgl control had increased mortality risk, but those on more relaxed control lived longer. As said above, it seems to be hypo's that is suspected.

My buddy (T1D and on pump) has also been advised to aim for an average of 10 mmol/l, but I as a T2D on orals and different doctor I have been advised to have a target of 7,0 mmol/l, which actually equates to the 42 HbA1c. The difference is that my oral meds are less likely to give me a deep or extended hypo, so are less problematic.
 
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Oldvatr said:
I think what is behind it was a study released last year that showed that diabetics on tight bgl control had increased mortality risk, but those on more relaxed control lived longer.
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Interesting, do you have a link to the study please?
 
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@NoKindOfSusie

Other than absolutes, science is hardly exact in the medical field or any other for that matter.. It never will be
 
Mike D said:
@NoKindOfSusie

Other than absolutes, science is hardly exact in the medical field or any other for that matter.. It never will be
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Yeah, but it would be nice to know if the driving limit is, what is it, five or ten.

Or whether it's actually necessary to take insulin, as we've had medics arguing it isn't.

Or which way is up. Or what colour the sky is.

You'd have thought we could figure THAT stuff out. But no.
 
NoKindOfSusie said:
Yeah, but it would be nice to know if the driving limit is, what is it, five or ten.

Or whether it's actually necessary to take insulin, as we've had medics arguing it isn't.

Or which way is up. Or what colour the sky is.

You'd have thought we could figure THAT stuff out. But no.
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The sky is any colour except blue, coz that is the colour it chucks out that we see.
 
NoKindOfSusie said:
Yeah, but it would be nice to know if the driving limit is, what is it, five or ten.

Or whether it's actually necessary to take insulin, as we've had medics arguing it isn't.

Or which way is up. Or what colour the sky is.

You'd have thought we could figure THAT stuff out. But no.
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It evolves ... look at drink driving regulations and how they've tightened over the decades. I was taking the holistic approach to science, not just medicinal.

But I do agree, it should be clearly defined where possible. No one is perfect and I don't wish to derail further :)
 
Draco16 said:
Ah, thanks... that study is of T2's though and the OP has T1... so I really hope her nurse wasn't referencing this study!!!
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Sorry. This one may be more relevant to T1D instead
http://care.diabetesjournals.org/content/diacare/26/suppl_1/s25.full.pdf

There are reports that tight control in T1D is beneficial as shown by the DCCT trials, but their target HbA1c was 8.6 minimum, and this was to avoid hypo's. Also the DCCT trials had to provide very high level of clinical support for the participants of the intensive therapy group, far more than is normally provided in the UK. Again the elevated target is significant and is above the 43 reported in the OP, so maybe the HCN was aware of this study.
Great HbA1c result but got told off for it...
 
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