Puzzled about HbA1c

[johnrubinstein]

Hi there

I'm 69 yrs old. I was diagnosed T2 in Dec 2017. I took measures: went down from 85k to 65k, started my own version of an LCHF diet (around 60-70gm carbs per day), tracked food daily on MyFitnessPal, started exercising (brisk walks mainly. 5k). HbA1c went down from 51 to 38, but over the past couple of years has crept up to 40 then 42 and just now to 44.

Once I lost the weight, I kept it down at around 65k. I don't allow it to go up more than 1-1.5 kg before taking measures). So weight has not been an issue (BMI is around 22). Exercise has been patchy over the past year (sprained hamstring and broken metatarsal). But recently I've resumed walks.

What I find strange is that though my HbA1c is creeping up my meter (I test 3-6 times per day) has been hovering around 6 for the past 2 1/2 years. That's been steady but my HbA1c creeping up.

My doc tells me over the long run that's inevitable. OK. I accept that. but why my daily checks so steady over long periods of time (except when I'm ill with a temperature), but my HbA1c creeping up.

Apart from being T2 all other parameters check out OK. The one other chronic condition I seem to have is a mild case of anaemia

Thanks for any feedback on this.

Thanks.

John.

 

[JohnEGreen]

Hi @johnrubinstein

As the HbA1c is an average of about 3 months and the finger prick measurements are a snap shot of levels at any one time they can miss peaks and troughs that are or maybe happening between measurements therefore the average over three months given by the A1c may be different to what you may expect from your finger prick tests.

Also it can depend on how mild your anemia is or isn't as it can skew HbA1c test results giving an erroneous result.

There are of course several possible different reasons for your A1c to be creeping up such as a change in insulin production or insulin resistance being among them.

 

[Tophat1900]

I agree with @JohnEGreen has posted. Low iron levels can falsely inflate hba1c numbers. So, if that isn't being addressed then that could explain the minor gradual creep. Your Dr seems to be of the thinking that T2 is a progressive condition, which isn't true. It can be if you follow standard dietary advice, but you are low carbing. Still it might be worthwhile if you provide a sample of what you eat for meals and people may be able to offer suggestions for you to consider.

 

[johnrubinstein]

Thanks @Tophat1900 and @JohnEGreen. Much appreciated.

I'll bring up the question of my anaemia and its possible influence on my HbA1c with my doc.

As for my diet, this is typically what I eat in a day.

I don't eat breakfast. At around midday I'll typically have 250gms full fat Greek yoghurt with 50gm blueberries and a couple of table spoons of linseed. Also a 3 egg cheddar cheese omelette cooked in a bit of olive oil.

At around 3-4 I'll have another bowlful of the Greek yoghurt (same as above).

For dinner, it's fish (about once every couple of weeks lightly breaded, but otherwise baked or sautéed with herbs in olive oil), or baked chicken, or a steak -- all this with a green salad (sometimes with mozzarella cheese or olives or tomatoes or avocado) and a green vegetable.

For snacks its either cheddar cheese or almonds. Or occasionally 90% dark Godiva chocolate (although I try to stay away from this as I can binge on a 90gm bar).

Takeout dinners (once a week) are generally Indian food, but here I'm careful to avoid fried foods.

Avoid all bread, pasta, rice, root vegetables (except carrot), all cakes (except the very occasional festive cake. e.g. birthday, Xmas, Jewish New Year, ), all fruit except berries and the occasional tangerine.

That's about the size of it.

Thanks guys.

John

 

[bulkbiker]

Thanks @Tophat1900 and @JohnEGreen. Much appreciated.

I'll bring up the question of my anaemia and its possible influence on my HbA1c with my doc.

As for my diet, this is typically what I eat in a day.

I don't eat breakfast. At around midday I'll typically have 250gms full fat Greek yoghurt with 50gm blueberries and a couple of table spoons of linseed. Also a 3 egg cheddar cheese omelette cooked in a bit of olive oil.

At around 3-4 I'll have another bowlful of the Greek yoghurt (same as above).

For dinner, it's fish (about once every couple of weeks lightly breaded, but otherwise baked or sautéed with herbs in olive oil), or baked chicken, or a steak -- all this with a green salad (sometimes with mozzarella cheese or olives or tomatoes or avocado) and a green vegetable.

For snacks its either cheddar cheese or almonds. Or occasionally 90% dark Godiva chocolate (although I try to stay away from this as I can binge on a 90gm bar).

Takeout dinners (once a week) are generally Indian food, but here I'm careful to avoid fried foods.

Avoid all bread, pasta, rice, root vegetables (except carrot), all cakes (except the very occasional festive cake. e.g. birthday, Xmas, Jewish New Year, ), all fruit except berries and the occasional tangerine.

That's about the size of it.

Thanks guys.

John

It might be that you are just above your own "personal carb threshold".

The blueberries have about twice as many carbs as raspberries and 500g of greek yoghurt daily (depending on brand) could also be relatively significant. Apart from that all looks pretty good.

6 I'd still consider a bit high and might try to lower it bit by reducing carbs and having more ultra low carb foods like eggs and bacon over the greek yoghurt?

Might be worth trying for a couple of weeks as an experiment? See if you can get your bloods into the low 5's.

 

[johnrubinstein]

It might be that you are just above your own "personal carb threshold".

The blueberries have about twice as many carbs as raspberries and 500g of greek yoghurt daily (depending on brand) could also be relatively significant. Apart from that all looks pretty good.

6 I'd still consider a bit high and might try to lower it bit by reducing carbs and having more ultra low carb foods like eggs and bacon over the greek yoghurt?

Might be worth trying for a couple of weeks as an experiment? See if you can get your bloods into the low 5's.

Thanks @bulkbiker. Greek yoghurt is 5.3gm/100gm. But will try to limit to one bowel per day. Don’t eat bacon but will try something else (cheddar, fish, beef steak). Will mix it up with the berries.

I’d be very surprised if I can get into the low 5s. My fasting sugar is typically in the 6-6.5 range (BTW, talking mmol\l not percentages) and, overall, I’ve averaged 5.8-6.1 over a ninety day period.

Thanks!

John

 

[bulkbiker]

But will try to limit to one bowel per day

Not sure that would be particularly appetising,... unless you like tripe of course, although that might help your blood sugar levels!
But good luck and please keep us informed.. maybe more eggs if bacon not an option or a nice no carb kedgeree without the rice?

 

[JoKalsbeek]

Thanks @bulkbiker. Greek yoghurt is 5.3gm/100gm. But will try to limit to one bowel per day. Don’t eat bacon but will try something else (cheddar, fish, beef steak). Will mix it up with the berries.

I’d be very surprised if I can get into the low 5s. My fasting sugar is typically in the 6-6.5 range (BTW, talking mmol\l not percentages) and, overall, I’ve averaged 5.8-6.1 over a ninety day period.

Thanks!

John

Oh, it's possible to go lower... You still eat more carbs than you need (Because wahey, we don't actually need carbs at all!). I had a fasting between 5,5 and 6,5 for a long time, sometimes I'd even hit a 7 if I fasted for very long and my liver was feeling particularly helpful, and dumping glucose like mad. Since I've gone carnivore, (Which is admittedly, very, very restrictive!), I am seeing lower to mid fours... So it can be done. Just depends on how far you're willing to go. Or how practical/workable it is for you to. Though with the anaemia, a bit more red meat might not be a bad idea as it is, as it can make your HbA1c look higher than it actually is. Your numbers still look pretty good, and keeping the anaemia in mind... I think you're doing better than your doc gives you credit for. (I'm not sure if a fructosamine test is more reliable in that case than a HbA1c is, but someone else'll know).

 

[ianf0ster]

Not sure that would be particularly appetising,... unless you like tripe of course, although that might help your blood sugar levels!
But good luck and please keep us informed.. maybe more eggs if bacon not an option or a nice no carb kedgeree without the rice?

Kedgeree made with cauliflower 'rice' is delish!

 

[johnrubinstein]

Not sure that would be particularly appetising,... unless you like tripe of course, although that might help your blood sugar levels!
But good luck and please keep us informed.. maybe more eggs if bacon not an option or a nice no carb kedgeree without the rice?

Just twigged on the spelling error.