Did I make a mistake reducing my hbA1c too quickly?

[Mrs SLD]

Hi all,

I am 42f and was diagnosed out of the blue in July this year as T2 with an hbA1c of 107. I had no symptoms other than a toe wound that wasn't healing well, my BMI was normal but I do have a family history of T2.

I am the sort of person that takes this kind of thing VERY seriously so I got to work on my diet alongside Metformin. I removed all sugary food and drink and used CGMs to modify my carb in take and learnt lots about what works for me/what doesn't. I put in a huge amount of work.

Fast forward to my retest in October and my hbA1c was 47. I was extremely relieved as was my diabetic specialist nurse who said her jaw was on the floor.

Anyway, I am continuing plodding along with my new life now, the diet feels pretty normal to me now. I was commenting on a separate forum (not within this site) about my diet etc and the person said what I had done was actually potentially dangerous? That dropping my numbers so quickly could have lasting damage.

I did have maculopathy in my eye screening which the nurse said could be related to the drop, but if it was then it was likely temporary. She didn't mention any other risks of reducing my numbers so swiftly.

I didn't engage further with this person as they were really down on my story and I have no idea of their qualification, but has anyone encountered any issues/heard of any problems with a steep swift drop? I guess I am a little fragile with things still so the comment threw me off a little. I don't have any signs of issues, I just feel a lot better to be honest.

Thanks so much

 

[Nicola M]

Although I am Type 1, I actually have experience with this, and it's amazing that doctors don't actually openly speak about the risks of improving your HbA1c so quickly. I think partly though, it's because there is limited data on it, but from what I know, a reduction of more than 3% (30 points) in your HbA1c in less than 6 months can sometimes cause Diabetic Retinopathy to worsen.

I'm not sure how eye testing differs between Type 1 and Type 2 and whether they follow the same protocols, but you should really be seen more often than yearly to keep an eye on your eyes, so I'd definitely query about that with your nurse. I am currently seen every 3 months to keep a check on my eyes and advise if treatment is needed. The Eye specialist has told me that so long as I keep my HbA1c under control, it should help my eye issues to settle, although it isn't going to be a quick fix, and it could be that the Retinopathy worsens and gets better, then worsens again (as has actually happened in my case).

An interesting study on the risks of reducing HbA1c swiftly - https://pmc.ncbi.nlm.nih.gov/articles/PMC6587545/

 

[Antje77]

I did have maculopathy in my eye screening which the nurse said could be related to the drop, but if it was then it was likely temporary. She didn't mention any other risks of reducing my numbers so swiftly.

I didn't engage further with this person as they were really down on my story and I have no idea of their qualification, but has anyone encountered any issues/heard of any problems with a steep swift drop?

I've only ever heard of potential eye issues with a quick drop, and nothing lasting.
Congratulations with your huge improvement, fingers crossed your eye issues will be temporary!

I'm not sure how eye testing differs between Type 1 and Type 2 and whether they follow the same protocols, but you should really be seen more often than yearly to keep an eye on your eyes

Once a year is standard if no issues, more often if there are indications of eye problems.
Once every 2 years is even standard in the Netherlands if no indication or history of eye issues, and fairly stable diabetes, no matter what type.

 

[rekotek]

My hba1c went from 135 to 41 in 4 months after diagnosed, with 2x1000mg Metformin and diet. I had 3 more tests after that first two 35 and 34, the last test was done in July hba1c 38 5 months after GP change my Metformin to 1x1000mg a day.

GP and nurse were both surprised about my result as they didn't expect me to get back to normal level.

I feel my body and eyesight got better after my hba1c came down, I currently do 1 blood test every year and eye screening every 2 years as I am no longer a higher risk patient.

 

[Mark Rawlinson]

I had eyesight problems due to my changing blood sugars luckily nothing serious mostly blurry vision close up. I do have to take my glasses off normally to read or see detail bit this was extreme. I wasnt told this can happen and was rather scared until an optician told me it was usual

 

[Mrs SLD]

Although I am Type 1, I actually have experience with this, and it's amazing that doctors don't actually openly speak about the risks of improving your HbA1c so quickly. I think partly though, it's because there is limited data on it, but from what I know, a reduction of more than 3% (30 points) in your HbA1c in less than 6 months can sometimes cause Diabetic Retinopathy to worsen.

I'm not sure how eye testing differs between Type 1 and Type 2 and whether they follow the same protocols, but you should really be seen more often than yearly to keep an eye on your eyes, so I'd definitely query about that with your nurse. I am currently seen every 3 months to keep a check on my eyes and advise if treatment is needed. The Eye specialist has told me that so long as I keep my HbA1c under control, it should help my eye issues to settle, although it isn't going to be a quick fix, and it could be that the Retinopathy worsens and gets better, then worsens again (as has actually happened in my case).

An interesting study on the risks of reducing HbA1c swiftly - https://pmc.ncbi.nlm.nih.gov/articles/PMC6587545/

Thanks for your reply. I am currently being screened every 6 months because of the maculopathy, so they are monitoring

 

[Mrs SLD]

That's amazing, glad to hear you have been well

My hba1c went from 135 to 41 in 4 months after diagnosed, with 2x1000mg Metformin and diet. I had 3 more tests after that first two 35 and 34, the last test was done in July hba1c 38 5 months after GP change my Metformin to 1x1000mg a day.

GP and nurse were both surprised about my result as they didn't expect me to get back to normal level.

I feel my body and eyesight got better after my hba1c came down, I currently do 1 blood test every year and eye screening every 2 years as I am no longer a higher risk patient.

 

[Mrs SLD]

I've only ever heard of potential eye issues with a quick drop, and nothing lasting.
Congratulations with your huge improvement, fingers crossed your eye issues will be temporary!

Once a year is standard if no issues, more often if there are indications of eye problems.
Once every 2 years is even standard in the Netherlands if no indication or history of eye issues, and fairly stable diabetes, no matter what type.

Thank you!

 

[Outlier]

I am T2 and dropped my levels very quickly by diet alone, because I am the kind of personality that really goes for it. I had blurry vision for a few days, but no lasting negative effects.