Hba1c Advice please

[olinmonsoon]

Morning,

I am just wondering if anyone can advise me on the safe Hba1c levels as I got mine done and it was 39 or 5.7%.

The doctors are going ape and contacting the Diabetic nurse because they advise it is too low.

I do a restricted bad carb diet. It's not really low carb as such but more than I just cut out potatoes/rice/bread/etc and eat lots of green veg and healthy proteins whilst restricting fat too. My Time in Target on my Libre is 97% with no high readings.

Can anyone advise if this Hba1c is okay or not? The doctors seemed agitated and as if it was an emergency but I have had hardy any hypos. Only a few and they were either due to exercise or starting to drop because my lunch was delayed or something.

Any advice appreciated please!

 

[In Response]

There is a fear that a low HbA1C indicates too many hypos.
However, that fear is based on people using finger pricks only.
A dedicated diabetes nurse is likely to understand this more than a generic GP.
If you have your 97% graphs available to share it should help alleviate their concerns.

Congratulations on your great results.

 

[ert]

Morning,

I am just wondering if anyone can advise me on the safe Hba1c levels as I got mine done and it was 39 or 5.7%.

The doctors are going ape and contacting the Diabetic nurse because they advise it is too low.

I do a restricted bad carb diet. It's not really low carb as such but more than I just cut out potatoes/rice/bread/etc and eat lots of green veg and healthy proteins whilst restricting fat too. My Time in Target on my Libre is 97% with no high readings.

Can anyone advise if this Hba1c is okay or not? The doctors seemed agitated and as if it was an emergency but I have had hardy any hypos. Only a few and they were either due to exercise or starting to drop because my lunch was delayed or something.

Any advice appreciated please!

They are worried about hypos. You have hardly any hypos, which is the case you need to argue. My HbA1c is lower than yours.

 

[EllieM]

As the others have said, it's the hypos.
Just been googling and found this interesting article
Study suggests new HbA1c 'sweet spot' to reduce risks of complications in type 1 diabetes - JDRF
Basically, low hba1c are associated with severe hypos and higher retinopathy (the latter because of the hypos).
Also, you are at risk of losing hypo awareness if you keep your bgs low, though I don't know if that is caused by low blood sugar or too many hypos....

From personal experience, pre having a cgm alarm, I lost hypo awareness once my hba1c went below 50, but I was having a lot of hypos.

 

[StewM]

I just wish more Doctors and Nurses were aware it’s possible to have a low HBA1C without frequent Hypos. Some clearly believe it’s the only way to achieve a low HBA1C which is just simply incorrect. I’m lucky in that I have a Consultant that understands this but I’ve had some Doctors and Nurses who have given me very bad advice by making completely incorrect assumptions about what my typical readings look like.

 

[olinmonsoon]

Hi all, thanks for responding!

Appreciate all the advice. When checking the “etimated A1c” on my Libre it says 40. So the 98% and 40 tie in together.

it’s really a case of them putting what they see in others on to me without being aware of what an average is.

if you test your blood five times and get 7, 11, 3, 2 and 12 you get an average of 7.

If you test it and get 7, 7, 5, 9 and 7 you also get 7.

they’re assuming I am the top because that’s the type of rises and drops you get on the diet advised by them.

Will fight my case and I have the data to prove it. Wish me luck!

 

[olinmonsoon]

They are worried about hypos. You have hardly any hypos, which is the case you need to argue. My HbA1c is lower than yours.

What sort of diet/plan do you follow?

 

[sgm14]

I am not sure if it is a valid concern in your case, but I was told that the reason some doctors and endos are worried about having such a low average is that your body may get used to those levels and hence would not send out the usual warning signs should you ever have a hypo. Even if you are currently hypo aware, they would be concerned about you losing it some time in the future.

Also, unless you have have had a few bad hypos, you don't know how your body will react, but confusion is a common symptom which means that some people get into a state that they are unable to correct the hypo by themselves.

Hence they worry that you go low on a day when your Libre alarms stop working and you don't recognize the signs until too late.

I don't know whether I have been very lucky, but the doctors and endos I have dealt with have been the type that like to inform and educate so I can make up my own mind, but from reading this forum, there do seem to be other doctors and endos that just want to dictate what you should do with any reasoning or explanation.

 

[jackois]

My GP was concerned that maintaining a lower level meant lots of hypos, particularly overnight and is still slightly skeptical each year at review time.

I do have my cgm data to refute this which gives some re-assurance, but as I rarely need to seek any medical treatment for anything else she only gets the opportunity anually and I just get on with life meanwhile.

 

[EllieM]

My GP was concerned that maintaining a lower level meant lots of hypos, particularly overnight and is still slightly skeptical each year at review time.

You see your GP and not a hospital endo? All the GPs I've ever had (UK, Australia and now NZ) have been only to relieved to handle my T1 care to a specialist.

And as for the suspicion and concern about low hba1cs, it's just a numbers game. Statistically, because a significant number of people have issues with them, a slightly higher hba1c is regarded as safer.

 

[StewM]

I am not sure if it is a valid concern in your case, but I was told that the reason some doctors and endos are worried about having such a low average is that your body may get used to those levels and hence would not send out the usual warning signs should you ever have a hypo. Even if you are currently hypo aware, they would be concerned about you losing it some time in the future.

Also, unless you have have had a few bad hypos, you don't know how your body will react, but confusion is a common symptom which means that some people get into a state that they are unable to correct the hypo by themselves.

Hence they worry that you go low on a day when your Libre alarms stop working and you don't recognize the signs until too late.

I don't know whether I have been very lucky, but the doctors and endos I have dealt with have been the type that like to inform and educate so I can make up my own mind, but from reading this forum, there do seem to be other doctors and endos that just want to dictate what you should do with any reasoning or explanation.

All this is true, but I believe extra context is required for the advice you were given.

Hypo Unawareness I believe occurs when your blood sugars are consistently running between 4 and 5 (at highest), which would mean an HBA1C of 30 or Lower (at highest mid-thirties) which is incredibly low.

Also, the scenario pointed out, whilst a possible one requires that you never check your blood sugars other than when your alarms go off (which is inadvisable considering Alarm malfunctions are a fairly common occurrence).

None of this is to say you shouldn't take precautions to prevent these sorts of outcomes, but I wouldn't say running an HBA1C in the low 40s makes these consequences inevitable. In fact, the logic outlined suggests they're assuming the HBA1C is achieved by running Low for long periods of time and that's offset by highs the rest of the time, which whilst possible, again isn't the only way to get your HBA1C to those levels.

 

[sgm14]

Hypo Unawareness I believe occurs when your blood sugars are consistently running between 4 and 5 (at highest), which would mean an HBA1C of 30 or Lower (at highest mid-thirties) which is incredibly low.
.

I thought there were a number of causes for Hypo unawareness.

..., but I wouldn't say running an HBA1C in the low 40s makes these consequences inevitable.

Did not mean to suggest that. (My own HbA1c is currently around 44 and I would not mind if it was lower). The point I was trying to make is a HbA1c of 39 may or may not be a good thing depending on the OP's circumstances and that I prefer doctors or endos who tell you why you should or should not do something, so you can decide for yourself.

 

[StewM]

I thought there were a number of causes for Hypo unawareness.



Did not mean to suggest that. (My own HbA1c is currently around 44 and I would not mind if it was lower). The point I was trying to make is a HbA1c of 39 may or may not be a good thing depending on the OP's circumstances and that I prefer doctors or endos who tell you why you should or should not do something, so you can decide for yourself.

That's fair enough, I wasn't not taking issue with your post. But the rationale you've outlined has been outlined to me with HBA1C never lower than 42.

With regards to other causes for Hypo Unawareness, I'm not aware of other causes, so if there are that's completely new information to me that I've not had access to.

 

[ert]

What sort of diet/plan do you follow?

Dr Bernstein's Diabetes Solution.

 

[olinmonsoon]

I must say that I have excellent hypo awareness. I also have my meter to alarm at 4.1.

I lost my hypo awareness a while ago when prescribed Propranolol for anxiety. Then I went high for ages eating carbs trying to avoid hypos as my hypo awareness disappeared. Then as my results started tonrun at say 8-10 consistently I felt like I was having hypos all the time but was at those levels. Then when I lowered it to around 5-7 the hypo feelings started again.

After a week or two the body normalised at these levels and my hypo feelings or sense kicks in at 3.9. Have actually seen my feeling hypoish and it is actually 4 at which point I have a glucotab to bring it up to 5-6.

That’s just me and my experience though!

 

[olinmonsoon]

Probably the most frustrating thing regarding all this is my Libre says I am in target 98% of the time and the Hba1c reflects the estimated one from the libre and they say it’s too low.

So which is it? I’m in target 98% of the time or I’m too low? Can’t be both?

 

[StewM]

I must say that I have excellent hypo awareness. I also have my meter to alarm at 4.1.

I lost my hypo awareness a while ago when prescribed Propranolol for anxiety. Then I went high for ages eating carbs trying to avoid hypos as my hypo awareness disappeared. Then as my results started tonrun at say 8-10 consistently I felt like I was having hypos all the time but was at those levels. Then when I lowered it to around 5-7 the hypo feelings started again.

After a week or two the body normalised at these levels and my hypo feelings or sense kicks in at 3.9. Have actually seen my feeling hypoish and it is actually 4 at which point I have a glucotab to bring it up to 5-6.

That’s just me and my experience though!

You raise a good point. The Hypo Awareness name is perhaps a bit misleading as we don’t have a sense exclusively for Hypos*. We just have a sense of Blood Sugar Equilibrium which is determined by our typical Blood Sugar Levels.

As such if you did run high consistently, even levels like 5-6 mmol/l could FEEL Low. This is a typical occurrence in newly diagnosed Diabetics.

So likewise with your current control you probably feel a bit “off” when your Blood Sugar levels are High. I know, I do.

*Though our awareness of Hypos is the most important use of jt.

 

[StewM]

Probably the most frustrating thing regarding all this is my Libre says I am in target 98% of the time and the Hba1c reflects the estimated one from the libre and they say it’s too low.

So which is it? I’m in target 98% of the time or I’m too low? Can’t be both?

Yeah it’s a tough one. Like Ert already advised you, I’d suggest highlighting you’re achieving your results without frequent Hypos and pointing to the data. Even the most stubborn Doctors or Nurses I’ve dealt with wouldn’t go as far as to dismiss clear evidence.