High Hb1ac but normal fasting

[Stay healthy]

Hi ,
My wife is T1 without taking any insulin. Her Hb1ac came back as 83 and 88 over the last 6/7 months. Her fastings (she does occasionally) come normal I.e below 7 in the morning. She has no problems as such but we are anxious that with consistent high Hb1ac something might be missing? She is on blood pressure medication (ramipril) and her blood pressure seems to be normal now. She is eating less carbs and does regular excercise so we were hoping for better Hb1ac but opposite seems to be coming. Any ideas why high Hb1ac please ?? Many thanks

 

[Stay healthy]

Just to add - she had her Covid vaccine in Feb . Would that have an impact on hb1ac?
She has lost weight by excercising and eats healthy as compared to when she first got diagnosed.

 

[Jaylee]

Hi ,
My wife is T1 without taking any insulin. Her Hb1ac came back as 83 and 88 over the last 6/7 months. Her fastings (she does occasionally) come normal I.e below 7 in the morning. She has no problems as such but we are anxious that with consistent high Hb1ac something might be missing? She is on blood pressure medication (ramipril) and her blood pressure seems to be normal now. She is eating less carbs and does regular excercise so we were hoping for better Hb1ac but opposite seems to be coming. Any ideas why high Hb1ac please ?? Many thanks

Hi,

Was your wife initially prescribed insulin on diagnosis?

 

[ert]

Can I ask why your wife as a T1 isn't on insulin? Did you mean T2?

 

[Stay healthy]

Hi,

Was your wife initially prescribed insulin on diagnosis?

No, we were told that she doesn’t need insulin immediately and should practice healthier lifestyle which she did and got her hb1ac to 50 without insulin. She then got pregnant and was put on insulin for the duration of pregnancy. After child birth, she was taken off insulin and was told to go back to managing diabetes with food and excercise. She has since lost all pregnancy weight and has become healthier in general ( dropped dress size etc)

 

[Stay healthy]

Can I ask why your wife as a T1 isn't on insulin? Did you mean T2?

Well since her diabetes is due to pancreatitis which she had as a child ( 12 year old) so she isn’t the typical t1 and hence they consider her as somewhere in between t1 and t2. Her body is insulin resistant not deficient is what we got told at diagonosis. Thanks

 

[StewM]

What you seem to be describing is Type 2 Diabetes.

 

[sleepster]

Hi @Stay healthy is your wife testing her blood glucose? My fasting BG is perfect, my hba1c is not because my BG is higher the rest of the day. It is an average so it would make sense if she is higher at other times, you've made no mention of other BG results/testing frequency...

 

[EllieM]

What you seem to be describing is Type 2 Diabetes.

Well the pancreatitis will be causing insulin deficiency (T3c) but insulin resistance is T2 and is often associated with gestational diabetes.

they consider her as somewhere in between t1 and t2.

Sounds like she has the dubious privilege of have T3c, T2 and GD. You could try seeing if she qualifies for the Abbott or dexcom free trials of cgms and then she'd find out what her blood sugar is like at other times of day (and night).

It's also possible that her hba1c has been artificially inflated by one of certain blood conditions eg anaemia. She could ask for a fructosamine test if she finds her blood sugars don't match the hba1c.

 

[Tophat1900]

Well since her diabetes is due to pancreatitis which she had as a child ( 12 year old) so she isn’t the typical t1 and hence they consider her as somewhere in between t1 and t2. Her body is insulin resistant not deficient is what we got told at diagonosis. Thanks

So, she would be T3c then and not T1.... very different.

I agree with @EllieM - a cgm would be most helpful to see what is going blood glucose wise. Sorry if I missed it, but when was she diagnosed?

 

[Stay healthy]

UPDATE : Aplogies was a bit panicky last night and was mixing a few things. I stand corrected and now based on wife's inputs here is what is happening.
At diagnosis (Dec 2017) - HB1Ac was 97 and she was not over weight so doc suggested to do a c-Peptide test which concluded she is insulin deficient but not dependent.
Advised lifestyle changes and low cards diet which got the HB1AC to 50 in May 2018. Now her Hb1AC seems to be shooting up again (83 and 88 last two readings) even though she is doing more physical activities. Her BMI is 24.4 which is normalish?
Question - I know 88 or 83 is high Hb1ac but wanted to understand how bad that is for someone who is not on any medication? Can we keep trying lifestyle changes to bring Hb1AC down again OR Is it time for us to consider medication or direct insulin? She has her doctors appointment on Friday so we will know more then.
many thanks

 

[Stay healthy]

Hi @Stay healthy is your wife testing her blood glucose? My fasting BG is perfect, my hba1c is not because my BG is higher the rest of the day. It is an average so it would make sense if she is higher at other times, you've made no mention of other BG results/testing frequency...

That could well be the case here too. She normally wont test in the day. Just fasting or Hb1ac is what we use as a basis to know how we are doing on diabetes.

 

[KK123]

Hi @Stay healthy, that makes more sense. It's a hard question to answer mind but if we accept she is type 2, are you able to say what a typical day's food is? I've just seen your post about not testing during the day, she really should as that will tell you a LOT about how her meals are affecting her. Otherwise you are driving blind. x

 

[Stay healthy]

Hi @Stay healthy, that makes more sense. It's a hard question to answer mind but if we accept she is type 2, are you able to say what a typical day's food is? I've just seen your post about not testing during the day, she really should as that will tell you a LOT about how her meals are affecting her. Otherwise you are driving blind. x

She doesnt test after meals. I have requested her to start doing that. Her typical meal would be a bowl of lentils, Halloumi cheese with bean salad, Paneer (indian cheese) etc. She doesn't eat any breads or rice etc.

 

[EllieM]

Advised lifestyle changes and low cards diet which got the HB1AC to 50 in May 2018. Now her Hb1AC seems to be shooting up again (83 and 88 last two readings) even though she is doing more physical activities. Her BMI is 24.4 which is normalish?

Is she still on the low carb diet? If she's still on it (and maybe even if not) my first recommendation would be to get a new cpeptide test, so as to see whether the issue is lack of insulin. Those hba1cs correspond to average blood sugars of between 12 and 13 mmol/L, so definitely needs treatment if she isn't already low carbing.

Good luck.

 

[KK123]

She doesnt test after meals. I have requested her to start doing that. Her typical meal would be a bowl of lentils, Halloumi cheese with bean salad, Paneer (indian cheese) etc. She doesn't eat any breads or rice etc.

Hi there, lentils & beans (dependent upon portion size) can still be a carby meal, if I have them I have to take only a little less insulin for them than when I have a slice of toast or a small bowl of rice or even a chocolate eclair!!. That's why if she tests after those meals she just might see a high number, there's a reason her hb1ac is so high. I think because beans etc are 'healthy' people think they are fine to eat but if you have diabetes they affect your glucose levels. As Ellie says above, it may be that her insulin production has changed but if it were me I would want to know definitely if it was still my diet causing me to go high before I looked at other options. x

 

[Tophat1900]

UPDATE : Aplogies was a bit panicky last night and was mixing a few things. I stand corrected and now based on wife's inputs here is what is happening.
At diagnosis (Dec 2017) - HB1Ac was 97 and she was not over weight so doc suggested to do a c-Peptide test which concluded she is insulin deficient but not dependent.
Advised lifestyle changes and low cards diet which got the HB1AC to 50 in May 2018. Now her Hb1AC seems to be shooting up again (83 and 88 last two readings) even though she is doing more physical activities. Her BMI is 24.4 which is normalish?
Question - I know 88 or 83 is high Hb1ac but wanted to understand how bad that is for someone who is not on any medication? Can we keep trying lifestyle changes to bring Hb1AC down again OR Is it time for us to consider medication or direct insulin? She has her doctors appointment on Friday so we will know more then.
many thanks

My take on it is that if she is deficient, then she will need insulin at some point. You can get away with not taking it for a while, but in the end being deficient equals a need for insulin. It may not be much, but it will be needed. Another c-peptide level to confirm would be a good idea.

With no testing during the day, that is a lot of lost info, but with a high climbing hba1c then I'm sure levels are rising up and there just isn't enough insulin present to cover food. If she is indeed deficient and how deficient.

 

[Stay healthy]

Is she still on the low carb diet? If she's still on it (and maybe even if not) my first recommendation would be to get a new cpeptide test, so as to see whether the issue is lack of insulin. Those hba1cs correspond to average blood sugars of between 12 and 13 mmol/L, so definitely needs treatment if she isn't already low carbing.

Good luck.

she is on low carb but we may be underestimating carbs in some of our cooking and that might be the reason for higher hb1ac. To be honest since she is keeping fit (with weight loss and her excersice routine) we stopped monitoring BG levels and just carried on based on the principle of like "exercise and have an occasional treat". C-peptide retest is a good call. will see if we can get that done soon. thank you so much

 

[Stay healthy]

Hi there, lentils & beans (dependent upon portion size) can still be a carby meal, if I have them I have to take only a little less insulin for them than when I have a slice of toast or a small bowl of rice or even a chocolate eclair!!. That's why if she tests after those meals she just might see a high number, there's a reason her hb1ac is so high. I think because beans etc are 'healthy' people think they are fine to eat but if you have diabetes they affect your glucose levels. As Ellie says above, it may be that her insulin production has changed but if it were me I would want to know definitely if it was still my diet causing me to go high before I looked at other options. x

that may well be the issue here. we lack planning and are vegetarians so kind of limited with "quick" food options.

 

[EllieM]

that may well be the issue here. we lack planning and are vegetarians so kind of limited with "quick" food options.

If you're vegetarian then you presumably still eat eggs and dairy? That gives you a lot more low carb options than vegan, but vegan is still possible.

The critical thing is how insulin resistant she is. If she's insulin resistant then low carb seems like a good idea, because her body can't cope with carbs and insulin just makes things worse. But if the issue is lack of insulin then insulin is her best friend and is really not the end of the world. (I've been taking it for 51 years and though there are aspects of T1 I hate, hello hypos, insulin has kept me alive and well and I am a big fan.)