Is HbA1c of 41 good for my Age (72)?

[Skyrider]

I am a 72 year old male who was diagnosed as pre-diabetic some 2 years ago, with an HbA1c level of 45.

I followed advice to lose weight & to go on to a low-carb diet.

12 months later, my HbA1c level was down to 41.

I have maintained my weight loss & the low-carb diet. After a further 12 months, my HbA1c is the same, 41.

In the UK this is considered 'normal' (just), but in the US it would still be considered pre-diabetic.

I'm a bit disappointed that I have not achieved a further reduction & I am wondering how realistic are my expectations.

I'm aware that there is more to blood glucose control than carbs & weight, for example certain mineral deficiencies, poor sleep, stress & I am affected by these to some extent. I am also led to believe that HbA1c tends to increase with age due to the body being less efficient at dealing with glucose.

So, my questions is: taking everything into account, is my current level of 41 reasonable, or should I be aiming for lower?

 

[lovinglife]

I think that’s an excellent HbA1c, not all of us can get into what is considered normal BG and we shouldn’t feel pressure to do so. Like you say there are lots of other factors not just food that affects our BG. All we can do is strive to be best we can be and it sounds like you do that

 

[Pipp]

Having had my ‘three score years and ten’, and being diagnosed T2 some 21years ago, with quite a few years HbA1c sitting in pre-diabetes levels more recently, I am quite content with that level of control. Though a recent HbA1c of 37 was a pleasant surprise.

@Skyrider, I would be very relaxed if I had your results. You have lost weight, and achieved, and maintained non-diabetes HbA1c. Well done!
Maintaining that is, in my opinion, an excellent result. You can strive for better, if that is what you wish to do, but my own feeling is that as a ‘senior individual’ I have less years of life left to worry about the long term possibility of diabetes complications than I had when first diagnosed. As long as I remain in low 40s HbA1c with no problems such as neuropathy, retinopathy, etc, I am not going to stress over numbers. Though I will remain on a low carb diet regime, and check bloods regularly, as only get annual diabetes review checks at GP surgery, and retinopathy checks are every two years.

 

[Mark Rawlinson]

As above I would say that is brilliant
I am approaching 65 soon and took me ages to get to a1c of 45 with insulin as well as diet
very very well done

 

[Skyrider]

I think that’s an excellent HbA1c, not all of us can get into what is considered normal BG and we shouldn’t feel pressure to do so. Like you say there are lots of other factors not just food that affects our BG. All we can do is strive to be best we can be and it sounds like you do that

Thank you for your reply & encouragement. Good luck with your own situation.

 

[Skyrider]

Having had my ‘three score years and ten’, and being diagnosed T2 some 21years ago, with quite a few years HbA1c sitting in pre-diabetes levels more recently, I am quite content with that level of control. Though a recent HbA1c of 37 was a pleasant surprise.

@Skyrider, I would be very relaxed if I had your results. You have lost weight, and achieved, and maintained non-diabetes HbA1c. Well done!
Maintaining that is, in my opinion, an excellent result. You can strive for better, if that is what you wish to do, but my own feeling is that as a ‘senior individual’ I have less years of life left to worry about the long term possibility of diabetes complications than I had when first diagnosed. As long as I remain in low 40s HbA1c with no problems such as neuropathy, retinopathy, etc, I am not going to stress over numbers. Though I will remain on a low carb diet regime, and check bloods regularly, as only get annual diabetes review checks at GP surgery, and retinopathy checks are every two years.

Thanks Pipp, that's encouraging. Interesting how you managed to get your level down to 37, well done you.

I take your point regarding age versus risk. Whilst I am happy that my level seems reasonable, I would probably be happier if it were a little lower. I had hoped that my most recent test would return a better figure after all the effort that I have made over the last 12 months & that I could relax a bit, but clearly I will have to keep going with what I am doing, if not more.

I also have a lack of perspective here: is a difference of 1 point significant? Does it represent a minor or major change in the condition?

Also, what does it take to achieve a difference of 1 point?

Good luck with your own condition, keep up the good work

 

[Skyrider]

As above I would say that is brilliant
I am approaching 65 soon and took me ages to get to a1c of 45 with insulin as well as diet
very very well done

Thanks Mark. It does seem to be a long, slow process. Having read up on low carb diets, I had hoped for a quicker/better result, but clearly it is not that simple.

Good luck with your own condition.

 

[Pipp]

I wonder if this resource from NICE Guidelines would be of use to you, @Skyrider?

https://www.nice.org.uk/guidance/ng28/resources/patient-decision-aid-on-type-2-diabetes-agreeing-my-blood-glucose-hba1c-target-pdf-2187281198

I don’t think many HCPs discuss personal targets other than the standard below 48 HbA1c for T2.
Have you been given a target range by your nurse /GP?
There is a tendency to be more relaxed about BG readings for those of us who are over 70. I believe this depends on the individual, and whether there are co-morbidities. My own nurse seems happy if I keep in pre-diabetes range, which she says is HbA1c below 53. I would regard that as too high for me, but would also not like to have finger stab readings regularly below 4.5 , because I feel light headed going much below that. I have already had a quite traumatic fall, and it is not something I would like to repeat.

What I would recommend would be to balance the pros and cons of striving to lower your HbA1c further. For example, are you enjoying your diet regime? Would you still enjoy if you were to cut carbs further? Do you need to take medication for any conditions? Are you having any signs of complications? ( neuropathy retina changes). The chart in the link might help answer these questions.

It is down to individual, preference and circumstances in making decisions about management. I don’t compare my results with others. Just satisfied to be proving the medical professionals wrong, because I have not had the predicted gloom they presented on diagnosis.

 

[Pipp]

I also have a lack of perspective here: is a difference of 1 point significant? Does it represent a minor or major change in the condition?

Also, what does it take to achive a difference of 1 point?

I believe there is a margin for error on these tests, and wouldn’t read much onto a difference of one point.

 

[Skyrider]

I wonder if this resource from NICE Guidelines would be of use to you, @Skyrider?

https://www.nice.org.uk/guidance/ng28/resources/patient-decision-aid-on-type-2-diabetes-agreeing-my-blood-glucose-hba1c-target-pdf-2187281198

I don’t think many HCPs discuss personal targets other than the standard below 48 HbA1c for T2.
Have you been given a target range by your nurse /GP?
There is a tendency to be more relaxed about BG readings for those of us who are over 70. I believe this depends on the individual, and whether there are co-morbidities. My own nurse seems happy if I keep in pre-diabetes range, which she says is HbA1c below 53. I would regard that as too high for me, but would also not like to have finger stab readings regularly below 4.5 , because I feel light headed going much below that. I have already had a quite traumatic fall, and it is not something I would like to repeat.

What I would recommend would be to balance the pros and cons of striving to lower your HbA1c further. For example, are you enjoying your diet regime? Would you still enjoy if you were to cut carbs further? Do you need to take medication for any conditions? Are you having any signs of complications? ( neuropathy retina changes). The chart in the link might help answer these questions.

It is down to individual, preference and circumstances in making decisions about management. I don’t compare my results with others. Just satisfied to be proving the medical professionals wrong, because I have not had the predicted gloom they presented on diagnosis.

Thanks for your further reply Pipp, you make some good points.

I have not been given a target range, they just seem happy that my level is in the 'normal' range. I'm trying to figure out for myself what would be optimum for my circumstances.

I have seen recommendations elsewhere that 38 or lower would be ideal for someone of my tender years but don't know how practical it is for me to achieve this and I'm curious as to what difference it actually makes as to what is going on in my body.

I'm aware that higher values can be recommended in certain circumstances in order to avoid hypos. Was your fall caused by this? I hope you do not have any repeats!

I'm pretty happy with my current diet regime. I initially reduced my carbs to around 70-80g/day, but felt unwell at this level, as well as finding difficulty in balancing fats/protein/fibre. I slowly increased up to 100g/day, which felt 'doable' but with some limitations. I'm currently on 120g/day, which I find to be very practical. I would prefer not to go lower, but would do so if it became necessary. It would be nice to be able to relax on the carbs a bit more, though!

No medication, no related symptoms.

Thanks for the link: I had a go at the chart & came out slap, bang in the middle!

Anyway, glad to hear that you have managed to confound the professionals in your own case

 

[Skyrider]

I believe there is a margin for error on these tests, and wouldn’t read much onto a difference of one point.

Sure. What I was getting at was what changes occur in the body if a change of 1 point is achieved. Does this represent a significant change to one's health? Also, how hard is it to achieve such a reduction? Does it require a huge effort, or is it easily attainable? As mentioned, my own level has stayed the same for 12 months.

 

[Pipp]

Was your fall caused by this? I hope you do not have any repeats!

I fell over a tree root. Broke a few bones. Don’t think it was due to blood glucose being too low. Though it does concern me that I feel disorientated if I do all BG to drop below 4 .

 

[Pipp]

Sure. What I was getting at was what changes occur in the body if a change of 1 point is achieved. Does this represent a significant change to one's health? Also, how hard is it to achieve such a reduction? Does it require a huge effort, or is it easily attainable? As mentioned, my own level has stayed the same for 12 months.

I confess I don’t know, for sure.
Though I believe the difference would be almost impossible to discern. Happy to be proved wrong.

 

[Skyrider]

I fell over a tree root. Broke a few bones. Don’t think it was due to blood glucose being too low. Though it does concern me that I feel disorientated if I do all BG to drop below 4 .

Ouch! Take care...

 

[KennyA]

I am a 72 year old male who was diagnosed as pre-diabetic some 2 years ago, with an HbA1c level of 45.

I followed advice to lose weight & to go on to a low-carb diet.

12 months later, my HbA1c level was down to 41.

I have maintained my weight loss & the low-carb diet. After a further 12 months, my HbA1c is the same, 41.

In the UK this is considered 'normal' (just), but in the US it would still be considered pre-diabetic.

I'm a bit disappointed that I have not achieved a further reduction & I am wondering how realistic are my expectations.

I'm aware that there is more to blood glucose control than carbs & weight, for example certain mineral deficiencies, poor sleep, stress & I am affected by these to some extent. I am also led to believe that HbA1c tends to increase with age due to the body being less efficient at dealing with glucose.

So, my questions is: taking everything into account, is my current level of 41 reasonable, or should I be aiming for lower?

Hi. Well done on taking control. 37mmol/mol is usually recognised as the mid-point of "normal" blood glucose - almost every non-diabetic person has a BG somewhere in the range 34-42 (see graph). This graph is taken from the Dutch Lifelines study but you'll find many others much the same. I wouldn't get too worried about the very recent moving of the goal posts in the US - they have a glucose control program to sell - by coincidence - and it might help sales if you define people with perfectly normal BG as "pre-diabetic".

There is a degree of error in the HbA1c test as with most things and I don't get too hung up about movements of a point or two. Mine has wobbled around 37 for five or six years now, sometimes a little lower, sometimes a little higher. There isn't a big enough variation to exclude testing error.

I don't think there's a simple answer to your question. I get high blood glucose symptoms (eg weight gain; oedema; kidney failure; neuropathy etc) when my BG is around 43 or 44mmol/mol: others don't get symptoms with much higher levels. It follows for me (I think) that I need to keep a tight control on my BG as even a small rise would have negative consequences. Others can maybe choose to be more relaxed. I'm also one of those who thinks that the term "pre-diabetes" is a misnomer - a non-normal BG is by definition T2 diabetes. There's absolutely nothing magical about the value of 48 mmol/mol that is chosen for diagnosis - it happens to match nicely to a US percentage measure (6.5%) and diabetic retinopathy is relatively rare at levels below 48.

As to how hard it is to reduce BG - in 2020 mine went from 50 to 37 in under four months. That was on the back of a way of eating that limited carb to around 20g/day. I've stuck to that more or less since and it works for me. Weight loss (around 90lbs) followed some way behind in the years after achieving normal blood glucose.

Best of luck. Reading around on the forum you'll see that there is no single "right" way to do things. What works for one may not work for another.