H1ac down to 6% but Consultant not happy.

[KK123]

Just been to see the Diabetes Consultant and his first words were 'Your h1ac is down to 6%, that means you're having hypos and it should be at 6.5. You're too tightly controlled'. Grrrr…..I felt like saying well if you give me a CGM, I can see if it is low between finger pricking.

He was a very nice bloke though, looked at my cholesterol of 7 (HDL 2.45, Trigs 0.5, LDL 4.45), said 'Ratios are fine, don't worry about statins'.

Sometimes you think you're doing everything right and you still get it 'wrong', ah well, onwards and upwards.

 

[Guzzler]

I'm giving you a trophy for doing your absolute best, always. And besides, is 6 really too low?

 

[Member496333]

Seems a bit of a stretch to asume you’re having hypos based on a HbA1c. It’s a little more nuanced than that. You could be having hypos at 8% for all he knows. Typical lazy thinking.

Still, at least he didn’t try to push statins

 

[KK123]

I'm giving you a trophy for doing your absolute best, always. And besides, is 6 really too low?

Thank you! I don't think it is too low to be honest, it just isn't exactly what they want it to be. I am very careful with my testing and insulin doses. He listened to me going on about my fairly low carbing and again, to be fair said absolutely fine but think about upping the carbs or lowering your insulin. I barely take insulin with meals and use 10 of lantus per day so I think I'll leave it at that for now. Thank you Guzzler & Jim for support as always to everyone. x

 

[Deleted Account]

This is a common view and I think with some reason - managing type 1 diabetes is hard as there are so many variables at work. Therefore, it is not difficult to overestimate your insulin requirements when exercising or eating something unusual and have a hypo.
As Hb1AC is a "blunt measurement" providing an average over 3 months, it provides no measurement of whether this is achieved through a BG in the range of 4 and 7 or a range of 2 and 11., for example.
I agree with the common view expressed on this forum that a CGM will help provide this evidence and improve type 1 management further. A CGM is not perfect - I have tried a few and found them much less accurate (and unpredictably so) than finger pricking but it is a better indication than Hb1AC.
Whether the assumption from the doctor is "lazy thinking" is hard to tell but I suspect the majority of people he sees have higher Hb1AC results with more hypos than someone following a low carb diet.

Well done @KK123 on your achievement and don't get too down on your doctor's comments. If you are happy with the way you manage your type 1, that is what is most important.

 

[Diakat]

You are doing great @KK123 you know how the numbers look and how you feel.

 

[Traceymac23]

Remember you are handling this thing to make YOU happy not the consultant........he can give advice and results but NOT be unhappy?

 

[Scott-C]

Lol, @KK123 , it's an excellent result and I wouldn't let the doc's attitude faze you!

As @helensaramay says, most docs will be more accustomed to seeing the majority of their T1 patients having way higher a1cs, so the alarm bells will be ringing a bit from a clinical point of view when they see lower numbers, because it just seems so unusual to what they normally see.

I've experienced that as well, but, to be fair, the docs have normally been quite willing to listen to how it can be safely done - basically just by not going above 9 or 10 that often.

A1c seems to be heavily influenced by high amounts for extended periods after meals, so if ways can be figured out to stitch that, prebolusing, split bolus, lower carb or whatever, a1c will safely plummet without going anywhere hypo land.

 

[michita]

I think your results are great. I feel consultants and DSNs tend to expect bad numbers from us therefore they feel comfortable most when they see bad numbers from us. when they see what they don’t expect they assume lots of hypos. Sad ...

 

[Hammer1964]

Just been to see the Diabetes Consultant and his first words were 'Your h1ac is down to 6%, that means you're having hypos and it should be at 6.5. You're too tightly controlled'. Grrrr…..I felt like saying well if you give me a CGM, I can see if it is low between finger pricking.

He was a very nice bloke though, looked at my cholesterol of 7 (HDL 2.45, Trigs 0.5, LDL 4.45), said 'Ratios are fine, don't worry about statins'.

Sometimes you think you're doing everything right and you still get it 'wrong', ah well, onwards and upwards.

My cholesterol is at 6 and on statins and going up! Will be seeing ny doctor I think.

 

[KK123]

Thanks to everyone as always for your unwavering support!!

 

[Robinredbreast]

Just been to see the Diabetes Consultant and his first words were 'Your h1ac is down to 6%, that means you're having hypos and it should be at 6.5. You're too tightly controlled'. Grrrr…..I felt like saying well if you give me a CGM, I can see if it is low between finger pricking.

He was a very nice bloke though, looked at my cholesterol of 7 (HDL 2.45, Trigs 0.5, LDL 4.45), said 'Ratios are fine, don't worry about statins'.

Sometimes you think you're doing everything right and you still get it 'wrong', ah well, onwards and upwards.

Rise above it, just rise above it

 

[Dillinger]

That's a great result. How do you feel about it? Are you having hypos? If you're happy and you are managing to avoid erratic hypos (i.e. ones where you can't explain them - we all have hypos at some point) then keep doing what you are doing.

The absolute worst piece of advice I ever got was a GP saying my HbA1c was too low (at 5.8% in old money - the lowest I'd ever got) and that made me think I'm doing something wrong/risky and so I did up my carbs and knackered that great control until I found this place.

I seem to remember Dr. Bernstein wants HbA1c's around the 4.6% levels but that's a bit of a stretch I think!

The reason your consultant was saying it's too low is that most people never get anywhere near that without skewing their results with loads of uncontrolled hypos - medical staff are just not used to meeting diabetics who know what they are doing. Good control from reduced carbohydrate is just not on their radar.

 

[kitedoc]

One of Dr Bernstein's talks mentions that in all his years of consulting the answer that keeps coming up when
he asks fellow physicians: Why do you prefer your patients' HBA1Cs > 6.5%?
They say they are likely to get sued if their patient has a hypo, so they prefer to have a patient's BSLs
high enough to prevent that.
Think about what that means for the patient !!

 

[KK123]

That's a great result. How do you feel about it? Are you having hypos? If you're happy and you are managing to avoid erratic hypos (i.e. ones where you can't explain them - we all have hypos at some point) then keep doing what you are doing.

The absolute worst piece of advice I ever got was a GP saying my HbA1c was too low (at 5.8% in old money - the lowest I'd ever got) and that made me think I'm doing something wrong/risky and so I did up my carbs and knackered that great control until I found this place.

I seem to remember Dr. Bernstein wants HbA1c's around the 4.6% levels but that's a bit of a stretch I think!

The reason your consultant was saying it's too low is that most people never get anywhere near that without skewing their results with loads of uncontrolled hypos - medical staff are just not used to meeting diabetics who know what they are doing. Good control from reduced carbohydrate is just not on their radar.

Hi Dillinger, I know that the vast majority of my readings are between 4 and 7. Yes, I do get a few hypos (into the 4s and sometimes 3s) and I deal with them. Obviously I don't know what is happening between finger pricking but generally, I feel well. I am happy with the 6% and can't see me getting much lower (without the aid of a CGM) because it is imperative in the job that I do that I don't go dangerously low. Having done numerous checks and experiments I know that if I use even so much as one more unit of insulin than I do, my levels plummet to anything between 2.9 and 3.9 so I guess the only way to combat that is to eat more carbs...which I don't always want to do. It's trial and error and balance and yes, at the moment I am happy.

 

[endocrinegremlin]

Only you know what your hba1c really means. few achieve your number by flatlines. that might be your doc's concern, but if you know you are healthy then just carry on and ignore.