got told off today by consultant :(

[howie]

so i had my hba1c today which came back as 4.9% i know this is pretty low but i'm still getting use to insulin adjustments per meal and i tend to overestimate if i'm unsure. 4.9's gotta be better than 7 or 8 though right? but my consultant said there' no evidence that an hba1c of anything below 6.6% will reduce the risk of comps. i do often go 'low' and i admit they're a bit too frequent but it seems it's either that or risk spiking.

also due to reducing my carb intake and increasing my exercise, i have lost 7lbs since seeing him last (which i didn't want). my bmi was perfect but i'd really like to be on the heavier side (muscle obviously lol).

thing is i don't think it's all my vigilant/inexperienced fault on the low a1c as a breakfast i was using 12 units for a coupla months ago is now still sending me low at 9 units. so i dunno if this is a bit of honeymooning? is there anyway of knowing? + the same thing just happened with my dinner.

howie

 

[hanadr]

Next time you see this consultant ask him what his HbA1c is. A non diabetic average is 5.1% and optimum is probably 4.6%.
Why then should he tell you off for 4.9%? He just doesn't know the Normal numbers.
There probably isn't any evidence that going below 6.6% reduces the rate of complications, because no-one has done theresearch and because not many diabetics achieve even 7.5%.
There being no evidence, doesn't mean that it doesn't happen.
Hana

 

[phoenix]

I was getting HbA1cs in the high 4s and my consultant wasn't happy either, I decided that she was right whenI realised that I was getting lower and lower before I realised that I was hypo. You only have to read the problems that some people with long term type 1 have with hypo unawareness to realise that this can be potentially serious. I'm now much happier with an HbA1c in the fives and better hypo recognition.
Yes lower levels equate to lower levels of complications but at lower levels the advantage diminishes and short term safety is also important.
This pair of graphs from the original DCCT study demonstrates the problem clearly
see fig 5.
http://content.nejm.org/cgi/content/full/329/14/977

I agree that some of your problems may be honeymoon related with your pancreas kicking in bit, the trouble is that it may be unpredictable for a while.

 

[kegstore]

howie that's a fantastic result, well done. If you can achieve this without too many swings then what's the problem? Any chance of you changing consultant? Be careful with your hypo awareness though...

 

[Debloubed]

Hi Howie, good job! personally, I think in the 4's is a touch too low as it is an average so means that you are running a tad too low over the months that the test calculates across........as others have said, watch your awareness (although if you lose it, you won't know until you have lost it so stupid thing to say, sorry! :lol I know non diabetics run in the 4's so it's good to aim for that but you are a diabetic, so what's good for non's isn't always good for 'us' if that makes sense?!

As for your meals which you are now dropping low after, just keep chippping away at your dose until you can find the middle ground - 12 units may have worked at first but if 9 is making you drop, knock another unit off and try 8 and see how you go? alternatively, try eating something else for brekkie and get on a DAFNE course as soon as you can

 

[Becca]

I know how you feel. I was only diagnosed in late July, and from the original H1AC of 14 have come down to 9 (early sept), then 5.9, then 5.3 (early Dec). My consultant gave me the proverbial pat on the head but followed it with some concern about hypos and low readings. I have had a few wobbles onto the low side but it's mostly due to the absolute terror that you're imbued with by Drs talking about all the appalling damage to your organs, sight, life etc etc if you go high. I have been careful but am now going to ease up on myself (eclair yesterday - yum! ). I think getting the balance right is extremely difficult as there seem to be Drs who bo**ox you for straying upward too much, and those who give you a talking to if you are even near the 4s. I think give yourself a break and don't worry about it too much. I don't know if you've read this, but it's interesting:

news.bbc.co.uk/2/hi/8287614.stm

 

[Debloubed]

etI have been careful but am now going to ease up on myself (eclair yesterday - yum! ).

Hi Becca, you can have eclairs occasionally and not go too high, just ensure you count enough carbs! I don't eat them often because of the pesky fat content (grrrrr!) but I do enjoy small amounts of chocolate and cakes but just make sure I count enough and dose enough accordingly - highs and lows are as bad as each other, find a middle ground as often as you can and enjoy the odd eclair - yum indeed!

 

[Fujifilm]

Next time you see this consultant ask him what his HbA1c is. A non diabetic average is 5.1% and optimum is probably 4.6%.
Why then should he tell you off for 4.9%? He just doesn't know the Normal numbers.

Its my guess that as a consultant he is aware of the "normal numbers" but being diabetics we are not "normal" its also my guss that the research and information he / she has to hand probably qualifys them to give best advice. Maybe Howie should refer her consultant to you. :roll:

 

[howie]

thanks for the replies & links guys, nice spectrum of opinions.

not sure i'd get on better with another consultant, weirdly i do really feel safe and trust him (maybe cos he was the only positive person i saw at diagnosis). though i am planning on a move into london in the new year so i might do then anyways.

+ i gotta think fujifilm has a point, this guy must be more qualified\knowledgeable than us about all this right?

i don't really have a prob with choc or anything, i think maybe i've been using to much insulin. basing my requirements on 'not spiking above 7' rather than returning to original level after 4 hours. but we eat every 4 hour approx right? so when do we every get the normal levels if we're running high in between? i dont wanna do low carb cos i don't wanna lose weight, i remember my thyroid test was pretty active but healthy so i guess i lose weight pretty easy with fast metabolism (good in the real world but not for db low carbing)?

feel like we can't win really lol, that middle ground is hard to find & also endlessly debatable.

howie

 

[Fujifilm]

Howie

Even after tewnty years I fail to understand it, I can go weeks getting it all right then even doing the same things I can have a few weeks where I struggle with it.

The way I look at it is, as long as I wake up in the morning I have a fighting chance of seeing the next day. :lol: :lol:

 

[Debloubed]

Howie

Even after tewnty years I fail to understand it, I can go weeks getting it all right then even doing the same things I can have a few weeks where I struggle with it.

The way I look at it is, as long as I wake up in the morning I have a fighting chance of seeing the next day. :lol: :lol:

totally agree! 'that which does not kill us, makes us stronger' etc, etc