My HbA1c is "too low"...

[PaulinaB]

Hi all!

So I had my first big check after diagnosis today. My HbA1c on diagnosis in February was 112 mmol/mol (12.4%), today it was 41 mmol/mol (5.9%). I can see from all the charts and stuff (and the doc said the same thing) that this is considered "too low", because it most probably means a lot of hypos. I do have hypos now and then and I don't feel them is they're not below 3.5mmol/l, but I don't consider them a big problem...

What confuses me is that 41mmol/mol is an equivalent of having average BG around 6.8mmol/l (my meter says it's more like 7.1, so considering the accuracy issues, that's close enough). How is having average BG of 6.8mmol/l bad? Or do they consider it very good, but need to make sure it's because my BG runs (for example) between 4-8(which would be ideal), and not between 1 - 10 (which would be terrible)?

Anyway, I'm very happy today!

 

[novorapidboi26]

I wouldn't have said it was too low, however going from 12.4 to the 5.9 that quick can sometime cause problems for folk, especially those with retinopathy for example......

good job though.....

 

[noblehead]

That's a great reduction Paulina

The concerns comes from the amount of hypo's people might be experiencing to achieve lower levels, if your hypo's are few & far between and you have good hypo awareness symptoms then I don't think there's anything to worry about.

 

[Desert Diva]

There is no pleasing some Doctors.... I am type2.My latest HbA1c was 5.3 which I was pleased with and my GP said they like their 'Diabetics to be around 6..' .. My highest before diagnosis was 5.8.!!?!? What am I supposed to do- go eat cake?

 

[Desert Diva]

BTW, Well done on your result Paulina!

 

[Indy51]

There is no pleasing some Doctors.... I am type2.My latest HbA1c was 5.3 which I was pleased with and my GP said they like their 'Diabetics to be around 6..' .. My highest before diagnosis was 5.8.!!?!? What am I supposed to do- go eat cake?

There is no justification for the doctor to say that to a Type 2 who isn't on insulin and/or medication that produces hypos. There is an article at Blood Sugar 101 about this very thing:
http://www.phlaunt.com/diabetes/35169265.php

 

[jack412]

There is no pleasing some Doctors.... I am type2.My latest HbA1c was 5.3 which I was pleased with and my GP said they like their 'Diabetics to be around 6..' .. My highest before diagnosis was 5.8.!!?!? What am I supposed to do- go eat cake?

If you aren't on hypo inducing drug, remind your dr that you are T2. He has it mixed up

 

[dawnmc]

Again no research. Blimey if we on this forum took it as read that there was no point being proactive, we would all be doomed.
Thank the lord we have brains and the internet.

 

[CollieBoy]

Hi all!

So I had my first big check after diagnosis today. My HbA1c on diagnosis in February was 112 mmol/mol (12.4%), today it was 41 mmol/mol (5.9%). I can see from all the charts and stuff (and the doc said the same thing) that this is considered "too low", because it most probably means a lot of hypos. I do have hypos now and then and I don't feel them is they're not below 3.5mmol/l, but I don't consider them a big problem...

What confuses me is that 41mmol/mol is an equivalent of having average BG around 6.8mmol/l (my meter says it's more like 7.1, so considering the accuracy issues, that's close enough). How is having average BG of 6.8mmol/l bad? Or do they consider it very good, but need to make sure it's because my BG runs (for example) between 4-8(which would be ideal), and not between 1 - 10 (which would be terrible)?

Anyway, I'm very happy today!

As you are a T1, not T2, you need to be careful about hypos! You say you don't have a lot of hypos, if so good, don't worry, just keep an eye on them in case they start to creep up!
Good work on getting things under control!

 

[PaulinaB]

Thanks everyone

 

[Heathenlass]

Well done, Paulina! That's quite an acheivement

You've obviously done a shed load of hard work to bring it down, and I feel you should be congratulated on this by your HCP's .It's a broad and sweeping assumption that a low Hb is due to many hypo's (and a quick look at your meter would confirm if you had or hadn't ) .

As I understand it, (from my own DSN ) it's common to have one or two mild hypo's a week if you are within the well controlled levels, and as long as they are mild, then it's not a problem.

I think your reduction is awesome

Signy

 

[PaulinaB]

Hmmm... I went through my diary from 1st June each day one by one. Until today, I had 11 days WITHOUT a hypo Oops... Half of those were hypos at 3.8 or something, so I don't consider them a big deal. But I can see a clear pattern, that a lot of hypos happened at the beginning of June and were caused by stuff like I didn't account for activity or took a wild guess with my insulin because I didn't have carbs info. And you can see them being less and less often as the month progresses So I'm clearly getting better at it.

@Heathenlass- what do you consider a "mild" hypo? I'm not really bothered by stuff above 3.5, I don't really feel most of them

Hehe, can you get a pump because you HbA1c is too low?

 

[noblehead]

Well if your leaning from those hypo experiences then there's no cause for concern, just keep an eye on things and try to catch them as early as possible, this way it will help you retain your hypo awareness symptoms.

 

[PaulinaB]

That's my BG since 1st June. Green background is between 4.5 and 9 mmol/l, yellow is between 4 and 4.5mmol. Is it completely terrible?

 

[noblehead]

A few highs there Paulina but looks OK, have you tried injecting ahead of your food? Scheiner talks about this in his book about getting the timing right so that postprandial bg spikes are kept to a minimum, if you've not tried it it's worth a go IMHO.

 

[PaulinaB]

A few highs there Paulina but looks OK, have you tried injecting ahead of your food? Scheiner talks about this in his book about getting the timing right so that postprandial bg spikes are kept to a minimum, if you've not tried it it's worth a go IMHO.

Like 10-15 minutes before the meal? Haven't tried that, maybe a good idea Thanks!

 

[noblehead]

Like 10-15 minutes before the meal? Haven't tried that, maybe a good idea Thanks!

That's it, he says you can leave it for as long as 40 minutes depending on the food eaten, tbh I wouldn't dare leave it this long but do inject 10-20 mins before food depending upon what I eat and bg readings, the book discusses all this and it's worth buying if you've not already got it.

 

[PaulinaB]

That's it, he says you can leave it for as long as 40 minutes depending on the food eaten, tbh I wouldn't dare leave it this long but do inject 10-20 mins before food depending upon what I eat and bg readings, the book discusses all this and it's worth buying if you've not already got it.

Yep, got it. I remember reading that part, and it sounded reasonable, but I never managed to implement it. But I'll try now - it may actually help with some of my hypos, since some of them are caused by "rage bolusing" when I'm high after a meal.

 

[Heathenlass]

Hmmm... I went through my diary from 1st June each day one by one. Until today, I had 11 days WITHOUT a hypo Oops... Half of those were hypos at 3.8 or something, so I don't consider them a big deal. But I can see a clear pattern, that a lot of hypos happened at the beginning of June and were caused by stuff like I didn't account for activity or took a wild guess with my insulin because I didn't have carbs info. And you can see them being less and less often as the month progresses So I'm clearly getting better at it.

@Heathenlass- what do you consider a "mild" hypo? I'm not really bothered by stuff above 3.5, I don't really feel most of them

Hehe, can you get a pump because you HbA1c is too low?

What my DSN described as a "mild hypo" in this context is pretty much what you are describing . Known causes such as unplanned for activity, over estimation of insulin, and BG's in low 3's .that are recognised and self treated. . Because we can't get it spot on 100% of the time, real life just isn't like that !

This came up because I think I was getting a bit obsessive about hypo avoidance, having had some crashingly low figures on Lantus , I'm keen to not go down that road again . My readings showed a pattern just as you describe, but on examination it's not the new insulins causing problems with hypos between 2 and 4 pm, it's work patterns at the moment with high bursts of activity that require more planning on my part now I know what's causing it.

Actually, a pump was mentioned in that convo for the very first time, but as my ears pricked up, she went on to say "well, that's a lot further down the line and we have other options to explore first " Bah!!

Signy

 

[Ellie 71]

I'm glad you posted this, this happen to my daughter when she was diagnosed. She went from 17.6 to 5.3 over 8 weeks. This was over the school summer holidays, no stress, lots of sleep, little formal exercise…… and with that first diagnosis brain where your just too good and struct about everything. Unfortunatly the hospital gave us a really hard time, so as a now just 14 year old she rebelled against the healthy breakfast cereals and with the return to school, welcome to my nightmare.
I expect you too have been really good with all the advice. Take some time to analyse the changes you have made. but don't act. just like with a 'diet' with time you lapse, but defiantly don't become more strict with your regime. give it a little time maybe ease up a little and let the body absorb the big changes of your meds. As a newly diagnosed person I suspect too that you have been working overtime mentally with all the information you have absorbed lately. Give your self the time to settle into a routine but watch the hypos. Keep accurate records, not just of meds but what you ate, excersise/stress, times of eating etc. its the only way you can really see the patterns of what is happening, you'll learn the hazards to try and avoid too.
Good Luck, stay healthy and strong