Hba1c 33 6 months since diagnosis

[michaeldavid]

I haven't felt shaky or sweaty with low blood sugar for 30 years.

The main symptom for me is anxiousness and difficulty thinking, or reading and suchlike.

With a certain light, my vision too will be affected.

I find it's the fast drops that are most dangerous by far. And I know these would return if I returned to a normal, Western diet.

Above around 3 mmol/l, I tend to get no significant symptoms at all.

I can usually function very well indeed at 2mmol/l. And I immediately take action, of course.

 

[Spiker]

I haven't felt shaky or sweaty with low blood sugar for 30 years.

The main symptom for me is anxiousness and difficulty thinking, or reading and suchlike.

With a certain light, my vision too will be affected.

I find it's the fast drops that are most dangerous by far. And I know these would return if I returned to a normal, Western diet.

Definitely agree the fast drops are the most dangerous, and anything to make the drops slower and easier to manage (as you successfully do) is excellent. Dealing with a "slow" hypo is a joy compared to dealing with a fast one.

It sounds like you have lost the first stage adrenergic warning signs and have the second stage neurological warning signs. I am lucky that I still have both. I had a very interesting experience recently when I took beta blockers. They block the adrenergic warning signs and suddenly I was managing via the neurological warning signs only. That requires more mindfulness, as the adrenalin warnings are like an alarm going off, but the neurological signs are more subtle and need to be looked for, or at least noticed.

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[kms1985]

I get hypo symptoms and when I check it's below 4, so I rectify this. The only time it might be affecting me is nighttime as I do wake up sweating, cos I did use to have this before I was diagnosed


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[Spiker]

I get hypo symptoms and when I check it's below 4, so I rectify this. The only time it might be affecting me is nighttime as I do wake up sweating, cos I did use to have this before I was diagnosed


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So it looks like the DSN's concern about the low HBa1c may be justified. If you can reduce overnight basal insulin and/or evening ratios, that should sort out the night time hypos and the waking up sweating. And since you may be in the honeymoon period, you might then be able to achieve an excellent HBa1c and still avoid night hypos. Having your cake and eating it.

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[mo1905]

I too was told my HbA1C was too low and was more or less accused of having to have regular hypo's to achieve it. I don't, I am just fortunate in that my levels seem pretty stable and don't take a lot of work although I do take lots of regular exercise. I will continue to aim for non-diabetic levels as it seems common sense ? My only fear is my consultant has input on my DVLA license application which is frustrating. So far, not been a problem but I certainly wouldn't actively increase it in order to maintain my license. If my control suddenly got worse I may have to re-adjust my plans.


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[mpe]

How can a HB1AC of 33 be classified as too low. My last HB1AC was 5.0 % or 31 and this was achieved without any hypos only tight (Non-Diabetic level) control.My Doctor didn't complain

It's odd that an HBa1c which is higher than "normal" can be considered "too low" when you consider that it's a fairly direct measure of DAMAGE caused by excess glucose in the blood. It's also not common to have records of HBa1c for someone from before they were diabetic, which would be needed to establish a "baseline".
(Whereas low readings for lipids, especially cholesterol, just tend to be waved away. Even though all human cells rely on lipids but only a very few cell types need glucose at all.)

Non-diabetics don't get diabetic complications so that is my target.

Someone eating a very low glucose diet could well have a very low HBa1c, without any "hypos", regardless of if they were diabetic or not.

 

[michaeldavid]

For safety's sake, I go to bed with the absolute bare minimum of insulin operating within me.

This means I take a bare minimum of slow-acting insulin (last thing at night). And I never eat a substantial evening meal. (The last fast-acting insulin I take is at 4.00pm.) But otherwise, I barely stop eating all day and evening. And I do eat very well.

 

[Spiker]

Someone eating a very low glucose diet could well have a very low HBa1c, without any "hypos", regardless of if they were diabetic or not.

True. The point at which actual hypos occur is going to be different (lower BG) for someone on a low carb diet because they are much less dependent on blood glucose and they are regulated to a lower level of blood glucose as being "normal" for them.

Non diabetic people can get hypos too. They are milder and easier to recover from and rarely progress to unconsciousness if untreated.


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[mpe]

Another way of looking at it is this. If you have an HBa1c of 5% and erratic blood glucose, you are definitely having hypos. If you have an HBa1c of 5% and stable blood glucose, you are not having hypos. Because HBa1c measures an average, but doesn't measure whether blood sugar is stable or erratic, the HCPs have to treat low HBa1c as a reason to investigate in case blood sugar is erratic, in which case low HBa1c will be an indicator of hypos. But low HBa1c does not necessarily mean hypos.

Is this investigation actually happening though. From what the original poster and others have said it sounds more as though the HCPs can be more concerned with raising HBa1c to some arbitrary figure. Which will do nothing to help with erratic blood glucose levels.

 

[mpe]

True. The point at which actual hypos occur is going to be different (lower BG) for someone on a low carb diet because they are much less dependent on blood glucose and they are regulated to a lower level of blood glucose as being "normal" for them.

I was more considering the situation of people getting the majority of their glucose from GNG rather than diet. Which is a different situation from most "low carb diets"

Non diabetic people can get hypos too. They are milder and easier to recover from and rarely progress to unconsciousness if untreated.

One of the normal responses to falling blood glucose is to stop putting insulin into the blood. This is impossible with an injection and would require continuious monitoring with a pump.

 

[Spiker]

I was more considering the situation of people getting the majority of their glucose from GNG rather than diet. Which is a different situation from most "low carb diets"

I was thinking of any ketogenic diet. Getting the majority of glucose from dietary protein via gluconeogenesis would definitely qualify but I think it's also true with less extreme reduction in carbs.


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[noblehead]

I get hypo symptoms and when I check it's below 4, so I rectify this. The only time it might be affecting me is nighttime as I do wake up sweating, cos I did use to have this before I was diagnosed

As you had night sweats before diabetes it' difficult to say if your having hypo's in your sleep, only way to determine this is to do some basal testing for a few nights.

 

[phoenix]

One of the normal responses to falling blood glucose is to stop putting insulin into the blood.

that is indeed one of the reasons why very low HbA1cs are associated with hypos in those who are truly insulin dependent.
Rapid Insulin lasts 4-5 hours in the body, if you have a level of 5.5 at 2 hours you may well be hypo at 4 hours especially if you then do any exercise.
I had a lower HbA1c than the OPs within 2 years of diagnosis. Statistically, I could demonstrate that according to finger prick tests (and I was testing frequently) , I had a very low standard deviation. I found that I was gradually getting warning signs at very much lower levels, warning signs were also more subtle and almost imperceptible during exercise . I made a conscious decision to accept my doctors advice and accept slightly higher levels especially for before exercise. (I also got a pump out of it but that's a different matter)
When you have had diabetes for longer there are other reasons that some people may be less likely to detect hypos.
This paper is specifically about what it calls the barrier of hypoglycaemia
http://diabetes.diabetesjournals.org/content/57/12/3169.full
Michael. I haven't the foggiest idea why you need so little basal insulin overnight. It doesn't seem to correlate with what I read about the need to curtail glucose from the liver but we are all different and it works for you.
I do know that for me feeding, the insulin all day, followed by not eating in the evening would mean I couldn't do the things I enjoy. I'll stick with relatively low HbA1c, an active lifestyle with a social life that includes eating in the evenings)

 

[michaeldavid]

I didn't say I don't eat in the evening - I just tend to eat less as the evening progresses.

I don't eat a substantial evening meal. Rather, I eat a moderately substantial early evening meal - always before 7pm.

And I'm sure that's a significant part of the explanation as to why I need so little overnight insulin: by the time I go to bed, my digestion of the day's eating is mostly finished. Though if I've eaten too much or too unwisely during the evening (or if I ate too much rye read earlier in the day), then my blood sugar would certainly rise overnight more than it normally does.

I did used to take a lot of slow-acting insulin - as I was instructed to do when first diagnosed. Indeed it was only a few years ago that it occurred to me I was needlessly risking night-time hypos by following the orthodox medical advice.

Unlike the orthodox method, mine involves neither guesswork nor the daily bed-time nightmare of indecision.

 

[Spiker]

@phoenix, that article is incredibly detailed and informative, thank you.

It is hinting that we should all have CGM, at a minimum. It's certainly made me much more appreciative of having access to CGM (when I can afford it). The CGM can replace those 1st and 2nd lines of hypoglycaemia defence (insulin and glucagon regulation) that are missing in Type 1s, and so hopefully preserve and protect the 3rd line defences (neurogenic) from fading.

I had no idea that as many as 10% of Type 1s' deaths were from hypoglycaemia. That is scary and sobering.

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[kms1985]

So tomorrow maybe they'll reduce my insulin


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[Spiker]

I should think that's likely, yes.

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[Bebo321]

I've had a call from DN today saying by hba1c is 33 which is too low, I need to see them on Thursday to find out what they are going to do. I think I'm taking too much insulin and might have nighttime hypos. If I am could this be why the result was low.

Thanks


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Old thinking "patients are incapable of managing BGs safely, so we make them stick to a high range"
New thinking "patients can self manage and are more than capable of achieving a 'normal' A1c"

Really well done! If you highs are 'low' and you don't wake up every day with a banging headache and feeling awful it's unlikely to be overnight hypos - keep up the excellent work!

Take a look at the facebook group Sporty Type 1, where there is a link to a you tube vid by Dr Troy Stapleton in Australia that talks about this.

 

[kms1985]

Went today, I've dropped my insulin doses and the DN didn't seem too worried about it being 33


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[Donna1]

I do not have a clue what ur hbac1 even is but from this forum it is evident that we are all being given conflicting information at our clinics which is quite scary!


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