HbA1c up - have been trying quite hard - what next?

[LittleGreyCat]

Just got my HbA1c results.
7.3%/56 mmoml/mol.
This is above the desirable level.

I relaxed my control over summer but have tightened up over the last couple of months but I don't seem to have pulled the numbers back to where I was a year ago.
Last year 6.8%/51 mmol/mol.

I have been as high as 7.3% before but managed to pull that back with diet and exercise.
However I now seem to be starting on the slippery downward slope.

I am eating LCHF and exercising (although not as much as last year) and am about 7 lbs heavier than the equivalent time last year.
However I am 6 foot tall and weigh 12 stone 2 lbs so I am well within normal BMI.

Can anyone recall slipping past the magic 7%?
What happened next?
Additional medication?
I am reluctant to take anything which carries the risk of a hypo but I'm not sure what else there is.

Any advice and similar experience welcome.

 

[shelley262]

Ive not yet been in your position but just wanted to send you a hug it’s so hard working out what’s causing it and what to do next.
personally I find stress more of an issue than what I eat but it’s all very complex and individual- hope your DN or GP may be able to come up with some sensible suggestions to help you manage things.

 

[RFSMarch]

When I was first diagnosed it was at the end of a long sting of travel and was able to bring my numbers down, able to decently LC etc... but back on the road up when the numbers and in the end I was pretty much burned out.

What meds are you on? Lockdown has done funny things to diabetics I know. With no travel and remote accreditation to tournaments, I have been able to far more successfully LC and intensify my exercise and have reduced my metformin and bloods are still ok.

My cousins (both diabetics) have put on weight - there is no one real/right answer .. and I echo the hugs.

 

[LittleGreyCat]

I am on the maximum (4 * 500 mg) Metformin.

I think almost anything else will carry a hypo risk and complicate my life enormously.
Mainly with the ability to drive.
I know I can do the testing before and every 2 hours but I would prefer not to go down that route.

Edited to emphasise that I am only (as stated above) talking about the impact of drugs with a hypo risk on driving.

 

[Resurgam]

When ignorance is bliss it is folly to be wise, but if being ignorant of your BG levels means you are worried by the consequences - well - are you sure that is the way you want to go?

 

[LittleGreyCat]

When ignorance is bliss it is folly to be wise, but if being ignorant of your BG levels means you are worried by the consequences - well - are you sure that is the way you want to go?

With respect, I have absolutely no idea what you are talking about.

 

[nutribolt]

I am so sorry that you have to go through this again when you had things in control in suchvrecent past but you may want talk to your surgery about moving from Metaformin to Jardiance.

It is newer medication and doesn't come with risk of hypo. While I was on max dosage of 2000mg slow release Metaformin, it was just not helping and I had lot of tummy aches and toilet runs which went away with Jardiance and it did bring the numbers down though in my case not to a level that would have helped.

LCHF is what is helping me.. that and CGM using freestyle libre but its one very expensive option as NHS wont prescribe unless patient is on insulin or a T1 diabetic... having said that ever since i started CGM with LCHF diet coupled with 4:3 intermittent fasting, my numbers have come in range that my eyes refuse to believe and brain finds difficult to process given my last 2 HbA1c were 90 and 86....

I have stopped medication completely as I was worried using medication with such numbers may get me into hypo... check the screenshot for my last 24 hrs CGM... everything is below 5.7... and 24 hour average is 4.7 ....

perhaps you might want to give 4:3 IF a shot

... hope this helps.

 

[Resurgam]

With respect, I have absolutely no idea what you are talking about.

I was asking if are you really sure you want to remain in ignorance of your BG levels and any medication which might help.
It is a well known phrase or saying -

 

[Goonergal]

Sorry to hear you’re struggling @LittleGreyCat I think there’s a lot of people in the same boat at the moment and the stresses and strains of 2020 can’t be helping with anyone’s cortisol stress levels.

I haven’t been through the exact same experience in that my numbers remain at non-diabetic levels, but they’re higher than they were a year - 18 months ago. Although I felt I wasn’t eating anything significantly different, or inherently ‘high’ carb, taking a long hard look revealed that just eating more than usual of say nuts, or even cream, or cheese, had the effect of nudging my numbers up. Not as ‘spikes’ but just generally keeping them trending a bit higher. As does eating more than twice a day. So for me, eating as close to zero carb as possible has to be the way - luckily I enjoy simple foods and am usually happy to do this (although lockdown has significantly increased my tendency to comfort eat.....)

Trying to look at it objectively, in the grand scheme of things a raise of 5 points on the HbA1c scale isn’t enormous - allowing for a bit of error either way with the previous result and the current one, it could be a bit smaller, but I know that I’d be equally as concerned as you if it were me!

Taking medication might be what your body needs, but I totally get not wanting the complications that possible hypos might bring. You say you’ve re-adjusted your diet over the past couple of months. Are there any further changes you’d be willing to try - even zero carb for a short period - so you can see whether drastic dietary measures would help? It’s always difficult as any change you make needs to be sustainable if you want it to be part of your long-term strategy, but in this case it might help gather evidence about whether you need to look at alternative medications.

Wishing you all the best with this.

 

[pm133]

Just got my HbA1c results.
7.3%/56 mmoml/mol.
This is above the desirable level.

I relaxed my control over summer but have tightened up over the last couple of months but I don't seem to have pulled the numbers back to where I was a year ago.
Last year 6.8%/51 mmol/mol.

I have been as high as 7.3% before but managed to pull that back with diet and exercise.
However I now seem to be starting on the slippery downward slope.

I am eating LCHF and exercising (although not as much as last year) and am about 7 lbs heavier than the equivalent time last year.
However I am 6 foot tall and weigh 12 stone 2 lbs so I am well within normal BMI.

Can anyone recall slipping past the magic 7%?
What happened next?
Additional medication?
I am reluctant to take anything which carries the risk of a hypo but I'm not sure what else there is.

Any advice and similar experience welcome.

In order to progress, you probably have no choice but to start testing your blood glucose levels before and after each meal to see what is keeping you higher than you'd like.
You mentioned in another post that you don't want to do this but I don't see what other option you have.

 

[Daphne917]

I am on the maximum (4 * 500 mg) Metformin.

I think almost anything else will carry a hypo risk and complicate my life enormously.
Mainly with the ability to drive.
I know I can do the testing before and every 2 hours but I would prefer not to go down that route.

It’s a shame you are reluctant to test as this will inform you as to what foods are increasing your BS. I used to test regularly but now I know what foods I can or should not eat I only do it occasionally or if I eat something that is more carby than usual to see the affect it has.

 

[DCUKMod]

My take on your first post @LittleGreyCat is your A1c has gone up by 5 points, during a time when the world has never before known such a turmoil. Clearly there have been global crises before, but there's never been a COVID known as 19.

Personally, I find stress impacts my numbers more than what I eat and drink these days. I've been fortunate to have pretty steady, decent bloods since pretty much being diagnosed, but I can almost track my stress levels in my A1c numbers.

When I had a period of a few months trying to work out a health issue, through surgery and results from that, my numbers twitched up a bit. I use twitch deliberately, because it wasn't a material rise, but it was there, for sure. When I go away for the winter, into a warm and calm environment, my numbers dribble down a bit - again immaterial shifts, but now predictable.

I doubt you have escaped some of the stress of COVID - whether the concerns over contracting it, frustrations of lockdown, not seeing family, playing golf or whatever else irks you. We were only talking over breakfast this morning saying how much more difficult it feels these days to shrug the shoulders in the face of some of the bonkersness around us.

If any of that chimes with you, it's worth considering.

In your shoes, I might be inclined to consider deferring any additional medication for a few months, and steel myself for a month or so of blood sugar monitoring - just in case you have some (for you) unusual reactions to certain food, drink or routines.

If you are feeling the frustration, then perhaps try to figure out how you can mitigate that. In this house, we regularly give the TV "feedback". We're pretty glad to be a mere twosome, sometimes, however, today I will be going out into the garden to tackle a few more areas, and get my breathing going - lugging heavy supplies and so on. I'll feel the better of it, although I doubt one of our ,awns will ever be the same, after my much too enthusiastic weeding, when too wet and at the wrong time of the year. Maybe I should add some patch re-seeding to the list of To-Dos.

It's a hard one LGC, and of course you know only you can decide your way forward. I wish you well with it.

 

[LittleGreyCat]

I was asking if are you really sure you want to remain in ignorance of your BG levels and any medication which might help.
It is a well known phrase or saying -

Two points:

(1) as discussed in various places I use a self funded Freestyle Libre.

(2) I am specifically asking about medications.

 

[LittleGreyCat]

In order to progress, you probably have no choice but to start testing your blood glucose levels before and after each meal to see what is keeping you higher than you'd like.
You mentioned in another post that you don't want to do this but I don't see what other option you have.

I specifically don't want to take a drug which REQUIRES me to test before driving and every two hours during a journey, because of the implications for driving licence renewal and insurance. This is the route that I do not wish to go down.
As stated in another response I am self funding Freestyle Libre so I have a very good idea of how my BG is trending throughout the day.

 

[LittleGreyCat]

It’s a shame you are reluctant to test as this will inform you as to what foods are increasing your BS. I used to test regularly but now I know what foods I can or should not eat I only do it occasionally or if I eat something that is more carby than usual to see the affect it has.

Please see other responses; possibly also check out my posts about Freestyle Libre.

 

[LittleGreyCat]

Further information:
I eat LCHF.
I also eat OMAD (if you discount the Bullet Resistant Coffee in the morning).
I walk over 2 miles, sometimes more, every day.
Until this latest lockdown I cycled over 20 miles once a week with a cycling group.

So I do diet and exercise and IF and I also monitor my BG ( although I find the variability of Freestyle Libre sensors constantly frustrating).

I could up my exercise, and make a concerted effort to lose half a stone but this is looking more and more like a last desperate rearguard action.
Exercising every day for long periods might help, but then that takes over your life and excludes most other things, including time with your partner.

Could I eat less?
Possibly, but I already eat very little and I am hitting the point where if I cut back further my metabolism starts to shut down and I feel cold in a warm house and also generally lacking in energy.

Hence the question about the next stage in medication, and for personal experiences.

 

[bulkbiker]

Could I eat less?

Or could you eat fewer carbs?
When you say "LCHF" what do you mean exactly?

Maybe keep a detailed food diary for a week weighing everything before cooking and see what your intake really is?
Carb creep is a thing and may explain some of your issues?

You did ask....

 

[Oldvatr]

Just got my HbA1c results.
7.3%/56 mmoml/mol.
This is above the desirable level.

I relaxed my control over summer but have tightened up over the last couple of months but I don't seem to have pulled the numbers back to where I was a year ago.
Last year 6.8%/51 mmol/mol.

I have been as high as 7.3% before but managed to pull that back with diet and exercise.
However I now seem to be starting on the slippery downward slope.

I am eating LCHF and exercising (although not as much as last year) and am about 7 lbs heavier than the equivalent time last year.
However I am 6 foot tall and weigh 12 stone 2 lbs so I am well within normal BMI.

Can anyone recall slipping past the magic 7%?
What happened next?
Additional medication?
I am reluctant to take anything which carries the risk of a hypo but I'm not sure what else there is.

Any advice and similar experience welcome.

From memory, the HbA1c test has an accuracy of about 1%, so a change of 0.5%, either way, may be an instrumental error. Discouraging I know, but maybe a kick in the butt is necessary on occasions to keep shipshape and trim. If it was me I would just tighten things up a bit, and wait to see what the next one is. Even at the current level, your risk of complications is still very low and recoverable.

 

[RFSMarch]

Just got my HbA1c results.
7.3%/56 mmoml/mol.
This is above the desirable level.

I relaxed my control over summer but have tightened up over the last couple of months but I don't seem to have pulled the numbers back to where I was a year ago.
Last year 6.8%/51 mmol/mol.

I have been as high as 7.3% before but managed to pull that back with diet and exercise.
However I now seem to be starting on the slippery downward slope.

I am eating LCHF and exercising (although not as much as last year) and am about 7 lbs heavier than the equivalent time last year.
However I am 6 foot tall and weigh 12 stone 2 lbs so I am well within normal BMI.

Can anyone recall slipping past the magic 7%?
What happened next?
Additional medication?
I am reluctant to take anything which carries the risk of a hypo but I'm not sure what else there is.

Any advice and similar experience welcome.

I sense your frustration with some of the responses so let's go back to your initial post.

I relaxed my control over summer but have tightened up over the last couple of months but I don't seem to have pulled the numbers back to where I was a year ago.
Last year 6.8%/51 mmol/mol.
I have been as high as 7.3% before but managed to pull that back with diet and exercise.
However I now seem to be starting on the slippery downward slope.

I burnt out pretty badly after my first year and while my numbers were not as bad as on diagnosis... they bounced back high and I needed to go back to basics. And that means pretty much coming at it like I did before. I went against my diagnosing GP and thankfully found an ally with a far nicer GP in my practice, BUT... I went right back to basics.

I am eating LCHF and exercising (although not as much as last year) and am about 7 lbs heavier than the equivalent time last year.
However I am 6 foot tall and weigh 12 stone 2 lbs so I am well within normal BMI.

I use My Fitness Pal and carb count with that - but I have been using MFP for ages so what I now do is create recipes or meals with as accurate a set up of what I am eating as possible. It honestly sounds like a bit of carb creep, lack of as much exercise and don't forget old Father Time has helped stack up half a stone.

If you are self-funding a Libre then I really do not see what the issue is with scanning the sensor. You obviously have an understanding of that and of trends so I am a little confused as to why not test when you eat.

I scan FBG, Pre & Post Prandial x 2 (Breakfast, Lunch & Dinner) and bed. During the blazing hot summer I had to scan on rounds of golf as I know I was tipping low at around holes 11-14 and with me exercise has always dropped my BG - I know others rise. That is why it is important to test.

Additional medication? I was put on Jardiance and that was upped when I fell off the wagon so to speak, and I now have decent ranges on 2xMetformin 500mg and 1 Jardiance 25mg. So worth asking your GP about that. FYI I set my Libre to the blood glucose ranges of a non-diabetic to see how far off the mark I am and generally with those meds I am stable.

Without being in insulin, you only alternatives really is to honestly assess what you are eating and its effect.
What, for you, is a good LCHF carb-count in your day? Below 100g? Below 80g, 50g? How consistent are you with that?

What has stopped you from exercising like you used to?

Just a few thoughts off the top of my head.

 

[LittleGreyCat]

If you are self-funding a Libre then I really do not see what the issue is with scanning the sensor. You obviously have an understanding of that and of trends so I am a little confused as to why not test when you eat.

Yet again (please see multiple responses up thread) I am concerned that taking any medication which carries a hypo risk will require me to notify the DVLA, and renew my licence more frequently, and test before driving and every two hours after.
This could impact my licence, insurance, and the range of vehicles that I am licenced to drive.
This is the testing regime that I am trying to avoid.

Hopefully it should be glaringly obvious that if I am going to the trouble and expense of self funding a Libre I will be scanning it and looking at the results.
Otherwise, why do it?
I don't see anywhere in my original post where I said or implied that I don't want to test in the normal course of the day.

I note that you did not quote the part of my OP+1 which talked about not wanting to test in specific circumstances.
So:
"I think almost anything else will carry a hypo risk and complicate my life enormously.
Mainly with the ability to drive.
I know I can do the testing before and every 2 hours but I would prefer not to go down that route."

I have highlighted the relevant sentence.
I have looked again at the OP and I do not see anything there which says that I don't want to test.

Edited for additional emphasis.