Good but disappointing HbA1c result

[Dougie22]

Three months ago, my HbA1c had come down from 65 to 48 and I felt there was scope for more improvement. Over the last three months I have been following a lower carb regime (not low by some standards at 130 to 150 grams per day) and testing fasting, 2 hours and 3 hours after dinner as a minimum. It seemed to be working pretty well as I have been getting better figures than I've had for some time with some sub 7s and many low 7s, and only the occasional 2 hr 8+ dropping to 7s at 3 hours.

So I was hopeful that my HbA1c would come in around 42. Just got my result from the surgery and although it has come down, it's only dropped from 48 to 46. Pretty disappointing. I know some people would be pleased with this result and it could be a lot worse but I'd convinced myself that I was getting near normal readings and that this would be reflected.

I'm seeing the doctor on Friday but I'm sure he will want to continue the current level of medication where as I'd hoped to be able to convince him to reduce it.

 

[walnut_face]

Chin up @Dougie22 , it's lower, allbeit not by much, and as you have identified at 130gms of carbs a day, you have some headroom. Now had you said you were eating 20gm carbs and only got a reduction of 2....................

 

[lovinglife]

A reduction of 2 is good - be patient and keep on doing what your doing - maybe tweak your carbs a bit - it's not a competition with anyone but yourself so any improvement should be celebrated!

 

[Brunneria]

I'm actually very, very, jealous.
If I was eating 130 g of carbs, my HbA1c would probably be in the 70s... or higher.

I am not telling you that to criticise, or imply you should drop your carbs, or anything, but purely and simply because... well... I'm deeply envious. lol.

 

[Phoenix55]

It is going in the right direction so you have developed a regime that is working. Be patient, keep going and see if there are other factors that are affecting your bs such as stress. You have also made the transition from a winter diet to a summer one, not many of us eat stews and hot soups during the summer so perhaps there is something there that can be adapted, little tweaks to bring the readings down to 5's and 6's. Let the disappointment fuel your determination that your next HbA1c will be better again.

 

[Robbity]

Don't be too disappointed, you've done pretty well so far!

You maybe need to test at one hour to see if you're getting spikes earlier. Our HbA1c is taking into account an average of all our glucose fluctuations not just the results we see from our spot check tests, and I've found those highs that I don't see have given me HbA1c results 2-3 points higher than those I'm able to predict from my 3 monthly average meter logs. And some of these highs can often also come from things that may be beyond our control, e.g. other medication, illness, infections, stress, and even sometimes the weather.

I think I have to agree with @Brunneria - and if I was eating as many carbs are you are, I'd be back where I started. After a big initial reduction in glucose levels, it took another 5 months of eating 25-30g carbs a day to get down from 47 to 40, and then to continue eating below 50g carbs to stay between 40 and 43 since then.

However this doesn't necessarily mean that you need to go down so low, just that some further reduction in carbs may help bring down your glucose levels more and/or possibly a bit faster.

Robbity

 

[nanny_ali]

I think that is pretty good and you should be pleased. Anything lower is good, even one lower is better than one higher.

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[Bluetit1802]

It is going in the right direction, and extremely good with that amount of carbs. I know how disappointing it is. I went up by 2 last time and I was gutted.

It may help you if you test more often, at least for a few weeks, and keep a strict food diary. An HbA1c of 46 equates to an average blood sugar of 7.6mmol/l over the period, so you are hitting those higher numbers more often than you think. Try testing at an hour, at 90 minutes and then half hourly until you are happy. Most peaks in most people occur round about 90 minutes give or take, depending on the combination of foods eaten. Some people find they peak a lot later, although I never have.

 

[13lizanne]

Hey! you are doing great @Dougie22 as the others have said, a wee bit tweaking and you'll be even lower next time

 

[JohnEGreen]

Don't be disheartened your doing well keep it up.

 

[Dougie22]

Many thanks for all of your supportive comments. They are much appreciated. I feel that this is the only place that I can discuss these things where there are people who are both knowledgable and helpful and I'm truly grateful for that. I'll go and see the doc on Friday and get that out of the way. I expect to stay on the same prescription but it's better than an escalation, which I was looking at six months ago. Going forward, I think I need to aim for more consistency, less lapses and try to get closer to my target 130 grams of carb per day. I have been at 150 or slightly more too often. If I can reduce a little further at this level, I'll be reasonably happy as I can eat "normal" food with the family and don't have to have "special" dishes with less common ingredients. I just have to be careful and selective and continue to make sure lower carb options are always available to me. Going back to a total loss of control ( as I did in 2015) is not an option! I also need to lose a bit more weight to reduce my BP.

 

[KevinPotts]

Three months ago, my HbA1c had come down from 65 to 48 and I felt there was scope for more improvement. Over the last three months I have been following a lower carb regime (not low by some standards at 130 to 150 grams per day) and testing fasting, 2 hours and 3 hours after dinner as a minimum. It seemed to be working pretty well as I have been getting better figures than I've had for some time with some sub 7s and many low 7s, and only the occasional 2 hr 8+ dropping to 7s at 3 hours.

So I was hopeful that my HbA1c would come in around 42. Just got my result from the surgery and although it has come down, it's only dropped from 48 to 46. Pretty disappointing. I know some people would be pleased with this result and it could be a lot worse but I'd convinced myself that I was getting near normal readings and that this would be reflected.

I'm seeing the doctor on Friday but I'm sure he will want to continue the current level of medication where as I'd hoped to be able to convince him to reduce it.

You are still to be congratulated. Is it time to consider a stricter LCHF say 50g-75g?

You'll probably find it straight forward in view of your existing restrictions


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[Robbity]

Going forward, I think I need to aim for more consistency, less lapses and try to get closer to my target 130 grams of carb per day. I have been at 150 or slightly more too often. If I can reduce a little further at this level, I'll be reasonably happy as I can eat "normal" food with the family and don't have to have "special" dishes with less common ingredients.

Don't make it too difficult for yourself - e.g. meat, fish, chicken, and above ground vegetables are all quite suitable for both low(er) carb and normal main meals, so you don't have to have special dishes! So for the most part you can eat the same as the family, just with variations on the starchy parts, e.g. caulflower mashed, roasted, grated for rice, or dry curried as a "filler" in its own right. Celeriac is another versatile vegetable and is readily available in supermarkets.

Robbity

 

[JohnEGreen]

I eat with my family and we eat for the most part exactly the same meals there are some really nice recipies that are lower carb and the family really like them.

My wife and daughter have also started losing weight which is a good thing as they both have been trying to lose weight for some time. Going LCHF does not mean giving up good tasting food au contraire.

 

[Keesha]

I have been watching a lot of Korean dramas lately and notice that the Koreans eat very little meat but a lot of noodles and kimchee which is mostly carbs, and they also eat only white bread. I suppose that would make a lot of them have high blood glucose. Wonder if Koreans get diabetes at a young age. Does any know? Just curiosity.


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[KevinPotts]

I eat with my family and we eat for the most part exactly the same meals there are some really nice recipies that are lower carb and the family really like them.

My wife and daughter have also started losing weight which is a good thing as they both have been trying to lose weight for some time. Going LCHF does not mean giving up good tasting food au contraire.

Absolutely...Yvonne has supported and joined me and she's not remotely diabetic and has fabulous,our metabolic markers and she's still lost 11lbs in 9 weeks


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[KevinPotts]

I have been watching a lot of Korean dramas lately and notice that the Koreans eat very little meat but a lot of noodles and kimchee which is mostly carbs, and they also eat only white bread. I suppose that would make a lot of them have high blood glucose. Wonder if Koreans get diabetes at a young age. Does any know? Just curiosity.


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I don't know about Korea specifically, but certainly the countries of the Pacific Rim who are principally rice eaters are experiencing the fastest growth in T2 globally


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[ChrisSamsDad]

I'd recommend keeping a diary of what you ate along with readings and see if you can see a pattern that way. It's so easy to miscalculate if you're going off memory alone. Humans are very bad at that, we have a very selective memory. Once you've got your hard data, look to see if there's one thing you can change each month or week to get your carbs/BS under control.

You've not mentioned exercise, it helps quite a bit alongside a good diet, and once you've got going, you'll find you want to be more active. A great start is to get a pedometer app on your phone if you can, and try to do the 10,000 steps, that'll be quite a few calories you're burning each day.

 

[Dougie22]

I'd recommend keeping a diary of what you ate along with readings and see if you can see a pattern that way. It's so easy to miscalculate if you're going off memory alone. Humans are very bad at that, we have a very selective memory. Once you've got your hard data, look to see if there's one thing you can change each month or week to get your carbs/BS under control.

You've not mentioned exercise, it helps quite a bit alongside a good diet, and once you've got going, you'll find you want to be more active. A great start is to get a pedometer app on your phone if you can, and try to do the 10,000 steps, that'll be quite a few calories you're burning each day.

I use the Myfitnesspal app to track my daily intake and it gives me both calories and carbs. It's easy to use, especially as you can scan barcodes on a lot of foods. I then enter the meal total carbs and daily total carbs and calories in a page per day diary along with my fasting, 2 hour and 3 hour readings ( and more if it hasn't gone down enough after 3 hours - now rare). I also enter gym exercise calories burned and use Mapmywalk which automatically updates the Myfitnesspal app. In the last three months I've been really good at keeping this up and I have lots of data now. Even so, it's hard to draw firm conclusions as my body seems to have different responses to the same inputs for no apparent reason. I can eat a set number of carbs one day and get a series of readings, then have an almost identical day a week later with different results. When I get an unexpectedly high or low result, I always take another reading in the same session. Sometimes it stays very similar, sometimes it goes back to what I expected. I've used several different meters though I now stick to my code free. The conclusion I have come to is that it's not an exact science and you can only use the numbers to give you an overall feel. I do still have days when it's not possible to make an accurate measurement ( staying away from home, restaurants, etc) but these are relatively rare and I'm comfortable with my approach to them which is to be a bit careful overall and not worry about detailed counting.

 

[KevinPotts]

I use the Myfitnesspal app to track my daily intake and it gives me both calories and carbs. It's easy to use, especially as you can scan barcodes on a lot of foods. I then enter the meal total carbs and daily total carbs and calories in a page per day diary along with my fasting, 2 hour and 3 hour readings ( and more if it hasn't gone down enough after 3 hours - now rare). I also enter gym exercise calories burned and use Mapmywalk which automatically updates the Myfitnesspal app. In the last three months I've been really good at keeping this up and I have lots of data now. Even so, it's hard to draw firm conclusions as my body seems to have different responses to the same inputs for no apparent reason. I can eat a set number of carbs one day and get a series of readings, then have an almost identical day a week later with different results. When I get an unexpectedly high or low result, I always take another reading in the same session. Sometimes it stays very similar, sometimes it goes back to what I expected. I've used several different meters though I now stick to my code free. The conclusion I have come to is that it's not an exact science and you can only use the numbers to give you an overall feel. I do still have days when it's not possible to make an accurate measurement ( staying away from home, restaurants, etc) but these are relatively rare and I'm comfortable with my approach to them which is to be a bit careful overall and not worry about detailed counting.

I use Withings Health Mate which also links wirelessly to my bathroom scales and provides me with all, the usual + my BMI, weight, fat mass, muscle mass, water mass, PMV which measures arterial health...technology eh...its increasingly wonderful


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