What is a dangerous HbA1c level

[davd]

After been diagnosed with HbA1c of 90 I have got it down to 40 for the last 9 months, but from an average finger test of 6 mmol/l it has now crept up to 7 which would put me in prediabetes range.
To be honest during winter months I have done little exercise and eaten not much but some foods I shouldn’t have .
I am getting totally fed up of not being able to just have a sandwich when I feel like one or a biscuit, and I am thinking I am 64 years old and don’t want to spend the last quarter of my life been miserable not been able to treat myself to something I fancy eating.
I don’t mean pasta or rice as I don’t like them, but a nice big cheese and pickle sandwich or a scone or even shepherds pie .
I know that if I eat more carbs it will push my levels up but how high can it go before it can cause serious health risks.
I have been eating about 60 to 80 carbs a day for the last 10 months which is moderately low carb diet but for the last 3 weeks I have been eating about 100 carbs a day and that is why my finger levels have increased, yesterday I had one medium size potato mashed with brazing steak and gravy it was lovely but 2 hours later my level was 8.7 .
I don’t intend going back to how I used to eat but I need to be able to have a sandwich now and again.
If for instance my HbA1c levelled out at 50 which would put me just in diabetic range would that cause long term health damage I need to eat normal foods now and again.

 

[bulkbiker]

I need to be able to have a sandwich now and again.

Why can't you just have the filling.. like a thick cheese slice spread with pickle, or maybe 2 cheese wedges with pickle in between?
All of the taste and very few carbs?

 

[SarahEN]

I don't really know the answer to how high is too high but I do think if I was in my 60's instead of 40's I'd be less strict on the carb front & generally consider that life was just a bit too short for all that faff. I still get bouts of 'sod it' thinking though. I find the only.wsy out is to give myself a bit of talking to & remind myself of all the things I still can eat.

Having said this doubt if the occasional sandwich would make a massive difference. Also, less than 100g carbs a day is generally considered to be low carb anyway. However if you want to eat them more often then it might be as simple as changing the bread. Have you tried the lower carb breads? There's a Burgen one I like to have on the odd occasion & it's about 12g carbs per slice so doable within a 100g carb limit.

Same also applies to biscuits & cake. The occasional rich tea is probably OK, but if you want 4 every day with your afternoon cuppa it might be worth a look at alternatives. I have recently discovered Fattbar - they do keto cookies which taste like Danish butter cookies but are the texture of cake & less than 2g carbs.

 

[Tannith]

After been diagnosed with HbA1c of 90 I have got it down to 40 for the last 9 months, but from an average finger test of 6 mmol/l it has now crept up to 7 which would put me in prediabetes range.
To be honest during winter months I have done little exercise and eaten not much but some foods I shouldn’t have .
I am getting totally fed up of not being able to just have a sandwich when I feel like one or a biscuit, and I am thinking I am 64 years old and don’t want to spend the last quarter of my life been miserable not been able to treat myself to something I fancy eating.
I don’t mean pasta or rice as I don’t like them, but a nice big cheese and pickle sandwich or a scone or even shepherds pie .
I know that if I eat more carbs it will push my levels up but how high can it go before it can cause serious health risks.
I have been eating about 60 to 80 carbs a day for the last 10 months which is moderately low carb diet but for the last 3 weeks I have been eating about 100 carbs a day and that is why my finger levels have increased, yesterday I had one medium size potato mashed with brazing steak and gravy it was lovely but 2 hours later my level was 8.7 .
I don’t intend going back to how I used to eat but I need to be able to have a sandwich now and again.
If for instance my HbA1c levelled out at 50 which would put me just in diabetic range would that cause long term health damage I need to eat normal foods now and again.

There are drugs like metformin that lower blood sugar just as much as a low carb diet without all the deprivation of your favourite foods that a low carb diet causes, and you have described as being a problem. If you have bad side effects from them you could ask your GP for a different version (eg slow release) of different drug.

 

[Dr Snoddy]

I too sometimes fancy a scone or a proper sandwich so I time them with bouts of exercise. So on a long walk I always have a prawn mayo sarnie usually on oatmeal bread on the understanding that I will walk it off. And occasionally I have a scone and butter just for the hell of it. However, I was diagnosed in my late 50s. Both my parents lived into their nineties and I am resigned to bring low carb for the rest of my life. I would rather be healthy in the long term

 

[Brunneria]

Personally, I wouldn't be happy with an HbA1c that took me up into pre-diabetes (which is 42 here in the UK)
I take the view that by looking after my health now, I reduce the likelihood of an unpleasant old age, with deteriorating eyesight, numb feet, kidney disease, leg ulcers, and so on.

So I stick to low carb now in the hope that I have a better, healthier, happier old age.

Both my parents are in their late 80s, so I like to think that I could have plenty of good health between 60 and 90 years, instead of a miserable, energyless, ill, old age filled with insulin resistance, hospital appointments, heart disease and needing more and more help around the house, which is more likely to happen if I run my blood glucose higher, and allow the insulin resistance to increase.

 

[Dr Snoddy]

There are drugs like metformin that lower blood sugar just as much as a low carb diet without all the deprivation of your favourite foods that a low carb diet causes, and you have described as being a problem. If you have bad side effects from them you could ask your GP for a different version (eg slow release) of different drug.

I disagree. Metformin has a limited effect on blood glucose levels compared to the impact of a low carbohydrate diet.

 

[davd]

I take 500gms of metformin extended release every evening reduced from 1000 I used to take but sometimes I still get bad stomach ache and need toilet a lot in morning.
When I first got diagnosed I was prescribed Glimepiride only 1mg lowest dose but that was sending my levels below 4 , but at the time I was only doing about 50 carbs a day so my doctor changed me to metformin .
I thought about asking to go back on Glimepiride but I worry it could damage my pancreas as it makes it work harder to make insulin, but it may help as I can relax my low carb diet a bit.
Saying all this I still want to keep my carbs moderately low and not go back to eating the **** food I used to .
It is encouraging to read what some members say I can treat myself occasionally but I don’t want to go down trying to find keto type food , I tried cauliflower rice and it was the most awful thing I have tasted .
Thanks for the advice folks it is most appreciated

 

[Roggg]

I tried to find info on what different levels meant for the various complications and it's info that is pretty hard to find. I did find that even moderately elevated blood glucose, sustained over time, creates a significant increase in risk for retinopathy and heart disease. The way I think it works is elevated blood sugar does damage. The higher it is, or the longer it stays high, the more the damage accumulates. Most of the damage is irreversible.

 

[DisneyGuy]

Low carb diet for me is no more than 130g, and no more than 30g sugar.

I can have cheese and pickle sandwiches in HOVIS low carb bread sold here in the UK.

My typical day consists of
Sugar free whole weat porridge made with almond milk

Low carb bread sandwich (normally ham and cheese, corned beef or peanut butter)

Then dinners are fairly normal, but I stay away from breaded foods and potato foods. Pasta and spaghetti do not affect me though as long as its weighed and I'm counting carbs.

Once a month I will have a naughty dinner like Mcdonalds or Dominos.

 

[davd]

I tried to find info on what different levels meant for the various complications and it's info that is pretty hard to find. I did find that even moderately elevated blood glucose, sustained over time, creates a significant increase in risk for retinopathy and heart disease. The way I think it works is elevated blood sugar does damage. The higher it is, or the longer it stays high, the more the damage accumulates. Most of the damage is irreversible.

That’s what I was originally asking and you have more or less answered it ,
So any elevated blood sugar level even only moderately say HbA1c of 50 which is only just above pre diabetes 42 to 48 is damaging but the higher it is the more risk .
Thanks Roggg .
I managed to get to 40mmol/mol so I will get back to proper lowish carb diet to keep it there

 

[KK123]

I tried to find info on what different levels meant for the various complications and it's info that is pretty hard to find.

I think that is because there are so many other factors that impact upon any damage being caused to a person. It all depends is usually the answer you get and I can see why! From a physiological perspective, our DNA is different, some of us may have heart issues or liver issues or excess weight or many other conditions that impact on our overall health. That's why some people with sky high levels can still live to their 80s without trauma (my Mum!!!) and others can fall by the wayside at 40. Also why some people can smoke quite happily without issue and others don't. Some very healthy athletes can still be unhealthier than a couch potato! Having said all that, I strongly believe that even if you had all the conditions listed above, you can improve your health by keeping your diabetes under control if it's possible.

 

[KK123]

Low carb diet for me is no more than 130g, and no more than 30g sugar.

I can have cheese and pickle sandwiches in HOVIS low carb bread sold here in the UK.

My typical day consists of
Sugar free whole weat porridge made with almond milk

Low carb bread sandwich (normally ham and cheese, corned beef or peanut butter)

Then dinners are fairly normal, but I stay away from breaded foods and potato foods. Pasta and spaghetti do not affect me though as long as its weighed and I'm counting carbs.

Once a month I will have a naughty dinner like Mcdonalds or Dominos.

Hi Disney, have you only recently been diagnosed? It's always interesting to see what a person can 'get away with' carb wise, please let us know what your next hb1ac is. x

 

[Andydragon]

There are drugs like metformin that lower blood sugar just as much as a low carb diet without all the deprivation of your favourite foods that a low carb diet causes, and you have described as being a problem. If you have bad side effects from them you could ask your GP for a different version (eg slow release) of different drug.

That’s not really the case

So there are drugs like metformin and more that may lower your levels. Metformin a little, others more. But they also have varying side effects and the big issue is that they will often progress into more and stronger until insulin is the end result.

even with metformin the advice is still to look to your diet. It’s not something you can fix with a pill I’m afraid

I started on 500mg of metformin plus Byetta (was a very early adopter) and 10 years later was on byetta, 2000mg of metformin and daplaflaglozin and would have been insulin later

now... how much could I have avoided by taking control and lowering my carbs. I am now drug free and lost a load of weight. I am also 44 years old. I do think of the lifelong changes I need. I also do occasionally have a treat but I follow with exercise where I can but yea, it’s hard at times but the overall risk to eyes and feet etc aren’t worth it

There are low carb treat options too like the choc mug cake, I need to look into more

 

[bulkbiker]

There are drugs like metformin that lower blood sugar just as much as a low carb diet without all the deprivation of your favourite foods that a low carb diet causes,

Again this is untrue I'm afraid. A low carb diet will have a far more beneficial impact on blood sugars than metformin and eating a high carb diet.

 

[MrsA2]

That’s what I was originally asking and you have more or less answered it ,
So any elevated blood sugar level even only moderately say HbA1c of 50 which is only just above pre diabetes 42 to 48 is damaging but the higher it is the more risk .
Thanks Roggg .
I managed to get to 40mmol/mol so I will get back to proper lowish carb diet to keep it there

The short answer is whatever level you are happy at. Me, I like to stay pretty strict so that I know I can have the very occasional real cake. Others are happy to have a daily limit that is higher to include carbs they really miss. Some adopt a lifestyle that includes alternative replacements rather than the real thing e.g low carb bread. It really is finding what works for you and not adopting all the strategies at once!
I don't miss bread at all, nor most carbs but I'd do find if temptation is there that often just a mouthful suffices. For example my son had hot cross buns the other day and not only did he toast them but then carried them through the house back to his room. The smell was heavenly, but rather than either having one of my own, or hating diabetes for not letting me have one, I just had one mouthful of his. That was enough to satisfy my craving and not enough to raise my bg. Win win.

 

[Goonergal]

There are drugs like metformin that lower blood sugar just as much as a low carb diet without all the deprivation of your favourite foods that a low carb diet causes,

Could you provide some evidence for that, please?

 

[lucylocket61]

There are drugs like metformin that lower blood sugar just as much as a low carb diet without all the deprivation of your favourite foods that a low carb diet causes, and you have described as being a problem. If you have bad side effects from them you could ask your GP for a different version (eg slow release) of different drug.

I am sorry, but that is not correct. It can lower blood sugar levels by UP TO 2% - which is NOT 2 points, but 2% of ones recorded level in a blood sugar test.

https://hopkinsdiabetesinfo.org/med...is very effective at,as 1.5% at maximum doses.

Lowering my carbs has reduced my blood sugar levels by an average of 6-7 POINTs (not percent)

 

[Tannith]

I disagree. Metformin has a limited effect on blood glucose levels compared to the impact of a low carbohydrate diet.

Do you have a link to a survey that shows this?
"Unless contraindicated, metformin should in Type 2 diabetes always be the oral hypoglycaemic agent that is initiated as first line. It is generally well-tolerated, not associated with hypoglycaemia or weight gain, and generally safe in the short and long term. Evidence has shown that metformin may offer benefits against cardiovascular disease in type 2 diabetes. NICE advises that in adults with type 2 diabetes if HbA1c rises to 48mmol/mol on lifestyle interventions: Offer standard release metformin in addition. [1] In UK Prospective Diabetes Study (UKPDS) this benefit was achieved at a relatively high dose of metformin (more than three quarters of patients received at least 1700 mg/day) so generally it is recommended that patients are titrated to a maximum tolerated dose. [2] Thus it is generally recommended that where clinically appropriate patients are titrated to a daily dose of metformin 2000mg, divided into two doses. NB: Any tolerated dose is beneficial."

https://hertsvalleysccg.nhs.uk/appl...in_GP_information_leaflet_v1.0_April_2018.pdf

 

[lucylocket61]

Do you have a link to a survey that shows this?
"Unless contraindicated, metformin should in Type 2 diabetes always be the oral hypoglycaemic agent that is initiated as first line. It is generally well-tolerated, not associated with hypoglycaemia or weight gain, and generally safe in the short and long term. Evidence has shown that metformin may offer benefits against cardiovascular disease in type 2 diabetes. NICE advises that in adults with type 2 diabetes if HbA1c rises to 48mmol/mol on lifestyle interventions: Offer standard release metformin in addition. [1] In UK Prospective Diabetes Study (UKPDS) this benefit was achieved at a relatively high dose of metformin (more than three quarters of patients received at least 1700 mg/day) so generally it is recommended that patients are titrated to a maximum tolerated dose. [2] Thus it is generally recommended that where clinically appropriate patients are titrated to a daily dose of metformin 2000mg, divided into two doses. NB: Any tolerated dose is beneficial."

https://hertsvalleysccg.nhs.uk/appl...in_GP_information_leaflet_v1.0_April_2018.pdf

That link and quote contains no information on its effect on blood sugar levels. Your bolded bit merely states that anyone with an HbA1c of 48mmol or more takes it. It doesnt specify the lifestyle intervention, or any blood sugar level information before the style interventions.

Following the standard Eatwell lifestyle interventions (low cal, low fat) put my HabA1c up. Thats when I started looking at alternatives.