Richard157 said:
My doctor tells me that any A1c below 6.0 is a non-diabetic level. He wants me to keep my A1c between 5.5 and 6.0. When I drop below 5.5 I have more than the usual number of hypos. My comfort level is 5.5-5.9.
I assume you are taking medications that can cause hypos?
If not on meds, or only those than do not lead to hypos (Metformin, Glucobay - and maybe others) then I see no reason why one should not try to achieve the middle or lower range of 'non-diabetic' A1c values.
My Dr. certainly encourages me to do so - but then I'm not ony any meds now, except for occasional use of Glucobay (Acarbose, in the US, I think) if I eat a bigger - and more carb-heavy - meal than usual.
It's pretty much a quality of life issue; I can find more fun things to do with the *extra* 4 hours a week that I'd need to exercise to stay down at 4.7
I'm happy at 5.1, yes, I'd be happier still at 4.7 but there appears to be little further reduction of all-risk mortality once the A1c level falls much below 5. (this assumes that the A1c reflects an 'average' PP/FPG response, obviously, some low A1Cs can happen with high PP but very low fasting, and all-causes early mortality risk maps very closely with PP, rather than fasting)
Similarly, the graph showing risk of progression from pre-diabetes to diabetes over a five or ten year time frame shows a trivial rise in risk if your fasting glucose goes up from 4.5 to 5.2, yet there is a horrifying rise in risk - ~5 times greater - if your fasting goes up to 5.5
When your fasting goes up to 6.1 or above, the risk of developing full diabetes in less than a decade becomes ~12 times greater than if your fasting is 5.2 or under.
Put more simply, ONE person in THREE with a fasting reading of 6.1 or higher will develop full diabetes within a decade.
When you consider the correlation between FPG and A1c, you'll easily see why, as a prediabetic, I am very keen indeed on keeping my A1c at around 5 or lower.
Once again, my approach is almost certainly *not* the right one for anyone on insulin or other hypo-inducing meds!
Markd