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A1C jumped after reversal - should I be worried?

E

EmDellit

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4
Hello all,

I was diagnosed with T2D 6 months ago aged 40 (A1C 7.3). I've managed to reverse it (woohoo!) but am stress about my new results:

Month 1-3: 800 cal a day, keto (10% vege based carbs), intermittent fasting. I lost 15kg. 2.3 stone.
Result: reversal to 5.3 A1C

Month 4-6: maintenance calories, keto/low carb, a lighter IF. I've lost 1-2 kg
Result: a shock increase to 5.6 A1C

I'm gutted by the result, and scared that this means I need to eat extreme keto for the rest of my life to keep my A1C low which is possible, but difficult.

Has anyone else experienced this? Any real-world advice would be appreciated, as the research seems very light. My doctor says that I can eat what I want as long as I keep the kilos off and shouldn't be worried about the result as long as it stays below 7.
 
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So you've gone from A1c 5.3% to 5.6%, that's an average glucose of 5.9mmol/L to 6.3mmol/L, it's relatively tiny in the scheme of things. Also there's +/- on these tests.

Accuracy is relative when it comes to A1C or even blood glucose tests, though. The A1C test result can be up to half a percent higher or lower than the actual percentage. That means if your A1C is 6, it might indicate a range from 5.5 to 6.5
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What does your home meter tell you, are you seeing improvements in fasting & postprandial readings ?.
Some of us have found it possible to reintroduce moderate crabs post remission but it varies for everyone.
 
Thanks Ronancastled! I've actually never used a monitor, or used metformin etc as my endocronolgist said I could try to reverse using diet along.

I just purchased the freestyle libre2 tonight, which is super expensive (how on earth do people afford $185 AUD every two weeks?!).

It's good to see we're thinking along the same lines - I want to collect some data on myself for a bit!
 
EmDellit said:
I just purchased the freestyle libre2 tonight, which is super expensive (how on earth do people afford $185 AUD every two weeks?!).
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Welcome to the forums.

You could just buy a testing meter and test your bg before and two hours after a meal. That would tell you whether a particular meal had too many carbs for you.

I agree with @Ronancastled in that that rise may not be significant.

Not sure whether your now prediabetic hba1c will entitle you to subsidised blood testing strips but it is still a lot cheaper than a libre.

In particular, the NDSS supplies subsidised testing stuff for diabetics.
 
EmDellit said:
I just purchased the freestyle libre2 tonight, which is super expensive (how on earth do people afford $185 AUD every two weeks?!).
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Do note you still really kinda need to check the libre reading with a blood test meter at least once a day, as they are certainly not foolproof, when I was still using the libre 1 it normally showed about 1mmol/L below what it actually was (but at least it was consistent for me)
 
I would disagree with the doctor here partially as from personal experience, dropping the weight hasn’t led me to being able to eat what I want, anything high carb and it shows in my blood levels. I had a pastie, 2 hours later bloods in the 11s and it took most of the day for the levels to drop. Although sweet foods like cakes and the spike and drop are much more rapid. I think it’s the fats and carbs combined in certain foods that cause a much more longer spike

for below 7, well, that’s really for you to decide. Personally I want below 42 (6%) as that’s the cut off in the UK for pre diabetes. Anything above 48 (6.5%) would mean diabetic, and I definitely don’t want that

regardless, the hba1c you quote is a small uptick and not necessarily a sign that it is in the wrong direction of travel

but if you increase carbs, it will probably go up, by how much and how much is acceptable is a personal thing

It’s why I don’t use the word reversal, as it’s not. I am and likely always will be T2 even if my blood tests show I am not but I am in a similar position now, starting to notice higher bloods but have also not been as good at the lower carbs (stress eating) and unfortunately even with lower carbs than ever before, it has an impact. I’m still okay, but it is a lifelong change. For me that isn’t keto, but I do need realistically low (<130g a day) carbs but also distributed through meals.

There does seem a real tipping point where carbs cause an issue for me, I’m finding about 40g a meal is probably okay, more and it causes an issue. But it’s also variable depending on heat, pain(after gym) or feeling unwell or cause it’s a Tuesday… sometimes food has no impact, other times it does. This condition can be so annoyingly random. Hence testing to the meter (I can’t afford cgm and I’d probably not like what I see)

but that’s I test
 
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I found that I can now have Muesli again! I keep it strictly to two tablespoons, mixed with two dessertspoons of Flax, Chia and Pumpkin seeds and it doesn't raise my levels
 
coby said:
I found that I can now have Muesli again! I keep it strictly to two tablespoons, mixed with two dessertspoons of Flax, Chia and Pumpkin seeds and it doesn't raise my levels
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As I said above I think there is a definite tipping point for some where the level of carbs is tolerable it may be that the amount of carbs you have in the muesli is just keeping you in the right level but anymore and it may tip you over, or not, it’s very unique

I founds some meals were okay so I start eating them (overnight oats it was for me) and then suddenly they aren’t. So I don’t take it as read that it’s always okay
 
I would take that as a warning shot across the bow rather than a real cause for immediate concern. It’s within a margin of error anyway, so may mean nothing at all. Always remember that even if you are 100% reversed with flatline glucose, sub 5% HbA1c and perfect fasting insulin, the mechanism that brought about diabetes in the first place can definitely bring it about again. Except the second time it’s probably more likely than the first. Keep calm and carry on. You’ll probably just have to accept that the keto-leaning lifestyle is a permanent part of your future. Personally I love it so for me it’s a joy, but I fully understand it may not suit everyone.
 
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Hi I have to say; remarkable diet program with great results.
15kg's and HbA1c 5.3 in 3 months? is there anyway you could let me know your diet program in detail?
 
Hi @EmDellit, I've just had something very similar happen. I was borderline prediabetic with an HbA1c of 41 (5.9). In three months I got it down to 31 (5.0) by eating around 50-60g of carbs a day (no rice, pasta or potatoes, and only low-carb bread) and running. However, I couldn't stop losing weight, so added in a few more carbs at the advice of a dietician, in the form of three Ryvita with peanut butter. This brought my daily carb total up to about 85g.

Unfortunately, three months later my HbA1c had risen to 37 (5.5)! This seemed to me a huge difference for an extra 25g or so of carbs. I also noticed my blood glucose was staying elevated for several hours after eating, rather than falling as normal. I've now cut out the Ryvita, and hope to see my levels return to normal again. It's a constant balancing act, isn't it!
 
I stayed low carb for two years after remission, only increasing carbs by 15g a day. Even now my binge days are just 20g extra on top of that.
I used a meter to test before and after every meal at first, to establish how many carbs I could safely have, after that I had one day a week testing plus tested after any new foods.
It was a lot to do, but thankfully now I just do a maintenance test once a week to make sure I'm stable.
 
There are many variables involved here such as 800 cals to presumably a higher caloric intake. From what Dave Feldman has said and the experiences of Peter Attia (I believe a 5.9, with a low flat CGM), this is not an uncommon phenomenon. This is also my experience, my lowest A1c was 5.3 and I am between 2 and 4 points higher depending on the testing assay; but my fasting blood glucose is lower and my post prandial rise is lower.

To further complicate matters when on CGM my A1c is predicted in the low 20's, and an A1Cnow averaging at 31.5 over multiple tests with a variance of around 0.5.

The advice to eat anything is just plain stupid.

I am a broken record, as resistance training and consistency with low carb I feel is best when reversal is attained.
 
Hi @EmDellit People have already pointed out that there is a margin of error on BG and even HbA1C readings, so no need to worry.
An HbA1C of 5.6 is still nicely into the normal 'non-diabetic' range.
You appear to have increased the carbs (rather than the fats) and have certainly increased the calories in your diet. Remission isn't the same as a cure, so most of us know that we still need to limit our carbs if we want to stay in remission. so I don't understand why you seemed so surprised at a rise in HbA1C.

I'm also puzzled by you saying that your 800 KCal keto regime was 10% vege based carbs. What does that mean - how many grams of carbs per day. Are you a vegan? Most people find it easier to do an animal based keto than a vege one since animal derived proteins come with a nice helping od fat and their nutrients are more bio-available than relying on vege based - which tend to come packaged with the carbs we are trying to avoid.
 
Usually putting type 2 into remission would require 3 annual tests in the normal range - so simply the time factor would be a problem here in the UK.
Control of blood glucose in the long term is pretty much all about the amount of carbs we can cope with.
By using a blood glucose meter you can see when it flags up an excess - and amend your menu in the future.
I am very suspicious of formulaic treatment, eating x amount for y days and reaching such a percentage change - it might work for some, or even most - but it is not tailored to the individual and can't ensure successful reduction in something if it isn't even being measured and checked, so it can't be adjusted for.
My regime might be considered extreme keto - under 40 gm of carbs a day, two meals, all delicious though, no calorie control - why do it if it isn't required for success?
After diagnosis I did lose 50 lb, but I wasn't trying to, I was only restricting carbs, down to 50 gm a day at that time, and then I was down into normal Hba1c levels. It was equally effortless to stay there year after year.
I am coming up to 5 years from diagnosis now - and seem to be getting better all the time. I eat under 40 gm of carbs a day, but it doesn't seem all that restrictive.
 
Hi how high were the bloods going on your meter? X. 37 a1c is fantastic. X
 
Hi @SuNuman,

Thanks! It was just a bit of a surprising jump in only 3 months. My post-meal readings won't really be comparable to most folk on here, as I test one hour from last bite (I had gestational diabetes and this was what we were taught to do - so I've continued with it for consistency). But I'd generally be seeing 5s and 6s on my meter x
 
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@EmDellit so the overall answer to hopefully help you not worry too much is that there is a small raise, it’s something to keep an eye on but still a fantastic result many would be very proud of.

extreme keto is your choice, but if you want to do differently there may be an increase, but you can monitor that and decide what you are happy with. There is advice out there to doctors for certain ranges. But many of us feel the range is a bit high for what we like, hence setting ourselves lower ranges.

regarding the eating what you want: I had fish and chips last night, bad I know. But a reading of 7.3 this morning as fasting. I’d normally be under 5, more recently due to not being as good (stressing about house moves and eating less well, less exercise) so quite a jump for me.

Eating anything is bad advice, I’ve said before but certain foods, and this is a perfect example of fatty and carbs causes me a high and sustained raise.

Didn’t do 2hr as I also did cardio on exercise bike and for me that reduces my levels for a bit

for some lucky ones, maybe they can eat whatever they like. But many in here report the same, no matter the weight loss or improvements carbs cause a problem

but as a one off, I can tolerate that. But I need to be aware one off leads to regular. That is the problem for me. I never lost my carb sweet tooth. Some of us don’t, some people find their tastes change and they dislike the food but in all honesty, some of us never lose that and acknowledging that is helpful for me

now, it was well over a decade, so maybe my body has permanent issues and lesser diagnosed time wise can do better but as I said, the reports of real life examples indicate not

For me, T2 is a permanent condition with lifelong changes. For the most part it seems I can keep lower carbs but it’s not fixed, hence always using term remission for me. But I can live without extreme keto, so I’m lucky but means I choose slightly higher hba1c than others, but for now, I’m okay with that

hopefully I can tell myself off a bit and get back to better levels, but that’s also the benefits of testing. To keep myself on track
 
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Jim it's a joy for me too. I LOVE my meals now and have introduced new foods, flavours and ways of cooking!
 
They are brill readings - Especially after one hour. X
 
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