How low is too Low for your HBA1C

[qbix]

Hi,

I was diagnosed as type 1 at the beginning of the year and put straight onto insulin with no tests done what so ever. My HBa1C at the time came out to be 91. As a consequence I completely changed my diet, no snacks, cut down processed carbs and reduced my carb intake to between 150 - 200 g a day.

My HBA1C was taken again in August and was down to 40. Happy days, my GP was delighted and so was I.

I recently had it taken again at the hospital and it was 41. Great. Or so I thought...

The diabetes doctor told me that I had to try and bring it up to about 50. Does this sound right to you? I am now starting to question my diagnosis, is it correct?

I take 8 units of lantus daily and between 0-5 units of novorapid per meal. I know that this is a really small amount, but I figured I was still in the honeymoon phase. If I do snack, or mis calculate my carbs my BS does go up and I can quite easily get it into double figures if I want. Pre breakfast my BS can be anywhere between 5-8 depending. My BS as a whole recently has been pretty good, but I have just moved house and have been doing about 2 hours of DIY every night.

Any thoughts or suggestions would be greatly appreciated

 

[hanadr]

Non diabetic Hba1cs are in the mid 4%s. so about22 -27. I'm trying to get there, but not succeeding at present [T2] 50 is a number that for me would be too high and my T1 husband is getting down there and a bit lower too.Surely the target must be Normal,
Hana

 

[Sarah69]

My hba1c was 5.2 in May and my consultant said it was too low!

 

[Pez68]

Hi, 3 months ago my test was 30, i'm T2, just told to carry on what I was doing, next test due next week full blood works. Dn never said my results were too low. Hope this helps in some way.

Andy


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[SamJB]

A lot of diabetic care professionals think that a low HbA1c is associated with a high hypo frequency. My HbA1c has been at 6.1% (43 mmol/mol) for a year now and every time I go in I get asked if I'm having frequent hypos.

The bottom line is, if you're HbA1c is low and you're not having frequent hypos then carry on.

 

[hale710]

I was diagnosed in February at 130. April I was 74-ish and September I was 43. I was very pleased with that, as was both the consultant and DSN.

I take 2.5 units levemir daily and between 0.5 and 3 units Novorapid per meal. Like you I'm in the honeymoon still

 

[paul-1976]

I have had a similar response from my DN with my HbA1c level of 31mmol being far too low and the subsequent risk of hypo's-total myth!! Haven't been low for a LONG time-just tightly controlled.

 

[Ambersilva]

I believe there are different targets for T1s and T2s. The level for T2s is lower than for T1s. I had a lengthy discussion with the new registrar at my last diabetic clinic appointment. My HbAic was 43. He had my daily results diary to examine. He asked me several times whether I have hypos. I told him that I know when I may be going low and respond appropriately. I have never had a severe hypo that requires the assistance of another person. He commented that 43 is too low for someone on insulin and I should aim to have it higher.

As a driver I am aware of the influence that he can have on my next licence renewal and I view his attitude to me as being detrimental to successful licence renewal.

 

[noblehead]

I think as long as your not experiencing frequent hypo's and still have your hypo awareness intact then there's no cause for concern here qbix, it seems to me by what you've wrote that your doing everything right :thumbup: ...... but appreciate your HCP's concerns just the same!

The question of what is too low for your Hba1c, well for me it's what I've wrote above, I personally wouldn't want an Hba1c in the 4's or the 5's although if I did drop down into the late 5's this might be acceptable if it wasn't at the cost of more hypo's and diminished hypo awareness. When I first came to the forum I always said I'd be happy with a Hba1c around 6, I've been in and around that figure for the last few check-ups and hope to keep it that way in the future, however I honestly think anyone who gets below 7 when taking insulin is do remarkably well.

 

[hanadr]

If your HbA1c were under 20, that might be a bit low, but around 30 is still higher than non-diabetic. Many healthcare professionals haven't a clue as to what a NORMAL [non-diabetic] HbA1c might be. And as Sam says they associate the lower numbers with frequent Hypos. Not to mention the dangers thrown up by the ACCORD estudy, which had an increased death rate for low HbA1cs. However, since logic shows that low numbers in and of themselves CANNOT be dangerous, It stands to reason that the method of achieving them wants examination. In the ACCORD study, people were given large doses of a wide variety[often multiples] of medicines. Since ALL medication has SIDE EFFECTS. I think that's where someone needs to look for the causes of the excess deaths.
Unfortunately many medics are not very good scientists, don't think things through [or can't!] and just regurgitate what they've learned by rote.
Hana
PS I know somw medics are good scientists, but I was once told by a consultant that 5% dextrose was just water, So he didn't understand the simplest thing.

 

[phoenix]

I think it's everything to do with hypos and not much to do with Accord (a T2 trial)
Mines been around 40mmol/l for a few years now. My consultant does go through my results and is happy at the moment that it doesn't include too many hypos so she's fine about it now. She wouldn't if she saw lots of hypos.

I did earlier on have a much lower HbA1c(30mmol/mol) which my doctors felt was too low but I was happy with it.
Because I probably still had a good counter regulatory system I was able to get away with it.
(ie my liver would respond to low levels by releasing enough glucose for the levels to rise again, a cgm showed that this was happening at night)
Unfortunately , the effectiveness of this counter regulatory system in T1 varies, it also seems to become less effective over time so it's not always going to be a get out of jail free card.
Eventually, I realised that during exercise I could miss the symptoms of a fall completely. One day, I got off my bike for lunch and found that I my meter read low yet I felt absolutely fine. It also happened during a busy shopping trip.(as soon as I knew I felt dreadful!)
I decided that my doctor's concern about too low an HbA1c was right and it was time for me to work with higher safety margins.

 

[donnellysdogs]

My consultant does not want my hba1c below 6.5....neither does my gp as they say that below that level and being a driver presents too much of a risk with hypo's.

 

[donnellysdogs]

Ambersilva...

Your consultant may not sign off your licence unless you get higher hba level... The dvla or consultant will not believe you if you say you recognise every hypo either.... They will then think that you are not actually recognising any. I have actually been told this by a person at dvla....

Be careful everyone if you are T1 and a driver with running your hba1c's under 6.0... Honestly you run the risk of being scrutinised by the dvla....

 

[douglas99]

Mine is 5.6%, which I believe is 38.
I'm interested in why 30 is now considered high?

Normal range for nondiabetic was always considered to be 4 to 6%. or 20 to 42.
Where has the new range come from?

 

[qbix]

Ambersilva...

Your consultant may not sign off your licence unless you get higher hba level... The dvla or consultant will not believe you if you say you recognise every hypo either.... They will then think that you are not actually recognising any. I have actually been told this by a person at dvla....

Be careful everyone if you are T1 and a driver with running your hba1c's under 6.0... Honestly you run the risk of being scrutinised by the dvla....

Thanks for that donnellysdogs. I can see where they are coming from as you don't want anyone dropping unconscious at the wheel whilst having a hypo, but on the other hand it feels like they are punishing good behaviour too. If I am able to keep my HBA1C at a really good level then surely that is a good thing as I will cost the NHS a lot less in the long run as I will hopefully not encounter any diabetic related issues that will cost them even more money.

It does seem to depend on who you talk to as my GP was happy, but my diabetic Dr was not.

 

[Paul_c]

Ambersilva...

Your consultant may not sign off your licence unless you get higher hba level... The dvla or consultant will not believe you if you say you recognise every hypo either.... They will then think that you are not actually recognising any. I have actually been told this by a person at dvla....

Be careful everyone if you are T1 and a driver with running your hba1c's under 6.0... Honestly you run the risk of being scrutinised by the dvla....

actually you should expand that to be careful if you are a diabetic on insulin and a driver with running your HbA1C's under 6.0.

T2's on insulin are subject to this paranoia about hypos and low hba1c's by the medics and DVLA as well... not just T1's

 

[iHs]

DD is very correct in what she has said about the a1c level. I knew about this a while ago

 

[donnellysdogs]

Yes, sorry about that... Everybody that injects insulin needs to be wary of their hba1c's being under 6 if needing to keep safe driving AND keep tbeir licences.

I know this from almost losing my license and talking a long time with dvla staff.
If you say you recognise all hypo's then they will assume that actually you're not recognising any....

Remember if you see a consultant the dvla will write to your consultant, not your gp. Its your consultant that will sign you fit or not... And they do not write these forms in front of the patient...unless you specifically ask them to..

 

[Ambersilva]

Ambersilva...

Your consultant may not sign off your licence unless you get higher hba level... The dvla or consultant will not believe you if you say you recognise every hypo either.... They will then think that you are not actually recognising any. I have actually been told this by a person at dvla....

Be careful everyone if you are T1 and a driver with running your hba1c's under 6.0... Honestly you run the risk of being scrutinised by the dvla....

I know DD. I got the impression that the registrar I saw could be dangerous. I'm not due for licence renewal until late 2015, so I will have three appointments before then. I have every intention of presenting him with printouts from my meter at each appointment so that he can see the range of my readings.

 

[ElyDave]

I'm doing DAFNE this week and they are saying that there is no increased risk is your HbA1c is between about 42 and 50. My last one was 46 (3 months after diagnosis at 130). They've given no clinical reason why you should not be aiming for "normal" other than their suggestion of no increased complication risk, but, in their view an increased hypo risk.

I've been running below 6 all week, which they really don't like at all.