Exactly how bad is bad (HbA1c)

[Mscmhs1]

Hi all,

Still learning all about type 2 (and feeling very in the dark).

I have a HbA1c currently of 51.

I understand below 42 is normal, 43-47 is pre diabetes and 48+ diagnosis threshold.

At the point of diagnosis a year ago, my HbA1c was 54. It then reduced to 51, reduced further still to 47 and is back up to 51mmol.

My GP says I don’t need medication but rather it’s a case of lifestyle changes.

So, a part of me wonders how bad “51” actually is. I mean I’ve seen some posts here of people being 100 plus.

I appreciate anything above 42 increases risk of strokes, heart attacks etc. But how significant is a 51 HbA1c given current guidelines?

Basically, is it a major concern or just something I need to be more considerate of? I’ve even started on Libre 2 but don’t even know if it’s necessary!

 

[LaoDan]

Not crazy high, but high enough to begin thinking about lifestyle changes.

 

[MrsA2]

the hba1c is an average over three months.
It won't show how high you've been going in that time.
Do you test your bg after food?

Edited to remove error

 

[Goonergal]

Basically, is it a major concern or just something I need to be more considerate of?

In many ways I think those of us who don’t get diagnosed until numbers are much higher (mine was 108) have an easier time mentally knowing that there’s no option but to make big changes quickly. So while an HbA1c of 51 is not a major concern now, it absolutely is an opportunity to take action before it becomes one - it’s a sign that your body isn’t using insulin effectively and if you ignore that, it could rise quite quickly.


(Edited for typo).

 

[Tannith]

the hba1c is an average over three months.
It won't show how high you've been going in that time.
Do you test your bg after food?
Each individual rise over 8.5 will be causing damage which may not show up for years

Each individual rise over 8.5 will be causing damage which may not show up for years Have you a link to where you read this please?

 

[KK123]

the hba1c is an average over three months.
It won't show how high you've been going in that time.
Do you test your bg after food?
Each individual rise over 8.5 will be causing damage which may not show up for years

Hi MrsA2, many non diabetics have individual rises above 8.5 and I should think just about every diabetic there ever was. My understanding is that generally, a rise above that, that then falls back into lower levels won't be causing damage but may do if it was a rise that stayed up above that permanently or rose to those levels every half an hour every day, etc, for prolonged periods of times whether months or years. Of course it is different for individuals too and other factors come into it so it may be that for some, ANY rise may affect them. I have 'individual rises' of over 8.5 most times when I eat but as far as I know (and have been told) that in itself does not mean that I WILL be damaging myself.

 

[Molts]

My GP says I don’t need medication but rather it’s a case of lifestyle changes.

Refreshing to see your GP didn't automatically whack you on meds. I was diagnosed at 94 in April 2018 and managed to drop it to below 40 in 5 months via a combination of diet and lifestyle changes. Consistently around 30 since so, yes, consider it a warning shot and take the opportunity to take action now in case your numbers become progressively worse.

 

[Mrs T 123]

Not major but not normal and if you take action now it should be easily/quickly controlled

 

[andersgb1]

the hba1c is an average over three months.
It won't show how high you've been going in that time.
Do you test your bg after food?
Each individual rise over 8.5 will be causing damage which may not show up for years

PLEASE, substantiate this last claim by a source!

 

[bulkbiker]

PLEASE, substantiate this last claim by a source!

Hyperglycemia is well know to be bad for us all for example..

https://www.diabetesdaily.com/blog/...sugar-can-cause-brain-damage-ada-2020-660359/

There are however thousands of others out there..

or did you mean the 8.5 specifically?

 

[Daibell]

A figure of 51 is not at all bad but needs a bit of attention. A change of diet should fix it. Keep the carbs down and replace with proteins, fats, veg and non-tropical fruit. My HBa1C at diagnosis was 110 and that was bad! There are meds if needed but hopefully you won't need them

 

[becca59]

Hi MrsA2, many non diabetics have individual rises above 8.5 and I should think just about every diabetic there ever was. My understanding is that generally, a rise above that, that then falls back into lower levels won't be causing damage but may do if it was a rise that stayed up above that permanently or rose to those levels every half an hour every day, etc, for prolonged periods of times whether months or years. Of course it is different for individuals too and other factors come into it so it may be that for some, ANY rise may affect them. I have 'individual rises' of over 8.5 most times when I eat but as far as I know (and have been told) that in itself does not mean that I WILL be damaging myself.

Plus that would mean Type 1s are scuppered. I regularly go above that number and often without food being an influence. Should I give up now

 

[oldgreymare]

Hi all,

Still learning all about type 2 (and feeling very in the dark).

I have a HbA1c currently of 51.

I understand below 42 is normal, 43-47 is pre diabetes and 48+ diagnosis threshold.

At the point of diagnosis a year ago, my HbA1c was 54. It then reduced to 51, reduced further still to 47 and is back up to 51mmol.

My GP says I don’t need medication but rather it’s a case of lifestyle changes.

So, a part of me wonders how bad “51” actually is. I mean I’ve seen some posts here of people being 100 plus.

I appreciate anything above 42 increases risk of strokes, heart attacks etc. But how significant is a 51 HbA1c given current guidelines?

Basically, is it a major concern or just something I need to be more considerate of? I’ve even started on Libre 2 but don’t even know if it’s necessary!

Hi @Mscmhs1, Unfortunately we all want certainty and precise thresholds when it comes to various health markers including HBAC1 readings, point in time BG reading, blood pressure measurements, lipid results and so on. Unfortunately biology just doesn't work like that and the guidance is always based on statistical probabilities of increased risk across a population of individuals. It doesn't necessarily predict your personal individual outcome, but can provide warning flags. So yes, a lower HbAc1 is likely to be less unhealthy than a higher value, but it is only one indicator of your overall metabolism, genetics, other health factors. Think holistically about how you want to manage your quality of life including your health.

It is great that you have invested in a Libre 2. If you are willing to use this proactively you can leapfrog to what is now being considered a better diabetic health marker than HbAc1 by tracking 'time in range' - keeping BG levels in a relatively narrow band of say between 4 and 10 mmol 70% of the time. This can give you a target to aim for and help you evaluate the impact of any lifestyle changes (diet, exercise, sleep, stress reduction) you try out.

 

[KennyA]

Hi all,

Still learning all about type 2 (and feeling very in the dark).

I have a HbA1c currently of 51.

I understand below 42 is normal, 43-47 is pre diabetes and 48+ diagnosis threshold.

At the point of diagnosis a year ago, my HbA1c was 54. It then reduced to 51, reduced further still to 47 and is back up to 51mmol.

My GP says I don’t need medication but rather it’s a case of lifestyle changes.

So, a part of me wonders how bad “51” actually is. I mean I’ve seen some posts here of people being 100 plus.

I appreciate anything above 42 increases risk of strokes, heart attacks etc. But how significant is a 51 HbA1c given current guidelines?

Basically, is it a major concern or just something I need to be more considerate of? I’ve even started on Libre 2 but don’t even know if it’s necessary!

I'm assuming you don't have any symptoms at all? Point here is that you have a question to answer: do you want to do something about your blood glucose levels now, or wait until they've gone higher? If they are stable for now around the range you've quoted, they are unlikely to fall of their own accord unless you make some changes. From where you are, you could easily be in normal range in 3-4 months. However, given that you are where you are because of some level of insulin resistance, it's possible that your body will become more insulin resistant over time and you are likely then to find more difficulty in reducing levels.

 

[MrsA2]

PLEASE, substantiate this last claim by a source!

I'm sure I learned it somewhere in the past year of research. It may take time for me to find it.
Else why are type 2 limits set at 8.5?
https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html

 

[Mr_Pot]

I'm sure I learned it somewhere in the past year of research. It may take time for me to find it.
Else why are type 2 limits set at 8.5?
https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html

The chart shows that the target for Type 2 diabetics is 8.5 or less 90 mins after a meal. This means that they will have a higher level earlier. The second chart shows that even non diabetics can have levels up to 11.1 if measured at random times.

 

[MrsA2]

thanks for the clarification. I have edited my earlier post

The chart shows that the target for Type 2 diabetics is 8.5 or less 90 mins after a meal. This means that they will have a higher level earlier. The second chart shows that even non diabetics can have levels up to 11.1 if measured at random times.

 

[jjraak]

I'm sure I learned it somewhere in the past year of research. It may take time for me to find it.
Else why are type 2 limits set at 8.5?
https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html

If it helps, I read similar in.
https://www.bloodsugar101.com/must-you-deteriorate



It's quite a long piece, but this section does present the outline of the idea..
(NB: not here to defend the piece, just offering it for perusal)

At the time UKPDS was published the 7.0% A1c was believed to correspond to an average blood sugar of 172 mg/dl (9.6 mmol/L). (Recent CGMS studies suggest the average might be closer to 155 mg/dl or 8.5 mmol/L) Whatever the actual equivalence, this average blood sugar level is considerably higher than the level at which neuropathy begins, arteries start to stiffen, kidneys begin to clog, and beta cell damage occurs--which we have documented HERE is 140 mg/dl (7.8 mmol/L) after meals and, in some cases, an A1c rising over 6.0%..

It does go on to various studies etc.
With the note regarding that an average could be made up off well controlled spikes, (good)
And less well controlled surges (bad)

It suggests spikes, as noted above by others, ARE part and parcel of the disease,
And to my untrained eye ( T2D) seems to contest that a type one will keep as in Range as possible with good use of insulin v food intake

In a similar way that a type 2, will try to reduce or eliminate foods that cause such a rollercoaster of rises

Both will have adherents doing that balancing extremely well and others who may be struggling or more relaxed with the food intake or method of attaining as much time in range as possible.

The best solution it suggests is being to limit the longevity of the spike with as good a management as possible.
Thus keeping that average, at a healthier level for the greater part of the day

@MrsA2 , it's horrible when you mention something, and quite rightly someone asks for a link or source., And you can't remember.
Been there a few times,

So hope this helps.