As usual Confused

[Dave_Wy]

Had my 12 monthly diabetic review with what I thought was good results with an Hba1c of 43 only to be told that this was to low and I should be looking for a target of 48. I do not have hypo's, my weight is good at 9st 7lbs blood pressure and cholesterol are both good. As a result of this I have had my medication of metformin reduced by half with another blood test in 3 months time with what appears to me that the diabetic nurse is looking for worse results!
Does anybody else get this sort of mixed message?

 

[ickihun]

I think your nurse is confusing your need to reduce meds as a problem. Argh!!!
It is infuriating. They don't realise how they say things come across as criticism.
Very well done on a brilliant hba1c which shows everyone you need to have your meds reviewed.
Well done.
I'm sure you'll have same great results in 3mths too.

Maybe close to reversal?
I don't think your dn has experienced this before. Take her/he along with your ride of reversing your tyoe2 diabetes. They need all the experience they can get.

I think theyve been lied to too much in the past due to carb cravings and past patients not wanting to admit to their relationship wasn't equal.

My dn is brilliant. We learn from each other!

 

[sally and james]

It is absolutely astonishing that there are still doctors/nurses who come out with this sort of rubbish. I'm afraid it just shows a lack of understanding on their part. Why, on this earth, would you want an HbA1c miles above normal or what nature intended? Ideal is low 30's or even high 20's.
You have done very well to get down to 43. Now you should be thinking about what you have done to get this far and then doing a bit more of it. Many Type 2's get their HbA1c's right down to normal or near normal and give up all diabetic meds, the secret is avoiding most carbs/sugars. My husband, James, is one. He completely turned his health round and that was four years ago.
Keep up the good work, your health is more important than keeping diabetes nurses in employment!
Sally

 

[chalup]

Mine is 37. My doctor was thrilled with me.

 

[keitjones]

Keep going that is an amazing result! Congratulations

 

[hca]

Well done on your results, as you can see I too bought y nba1c down and came off all meds. Keep up the good work.

 

[leslie10152]

Had my 12 monthly diabetic review with what I thought was good results with an Hba1c of 43 only to be told that this was to low and I should be looking for a target of 48. I do not have hypo's, my weight is good at 9st 7lbs blood pressure and cholesterol are both good. As a result of this I have had my medication of metformin reduced by half with another blood test in 3 months time with what appears to me that the diabetic nurse is looking for worse results!
Does anybody else get this sort of mixed message?

Welcome to the forum @Dave_Wy. That you have reduced your Hba1c to 43, she should be pleased! Don't let these doomsayers put you off. You are doing well so take heart. @ickihun nailed it in one!

 

[Squire Fulwood]

Had my 12 monthly diabetic review with what I thought was good results with an Hba1c of 43 only to be told that this was to low and I should be looking for a target of 48. I do not have hypo's, my weight is good at 9st 7lbs blood pressure and cholesterol are both good. As a result of this I have had my medication of metformin reduced by half with another blood test in 3 months time with what appears to me that the diabetic nurse is looking for worse results!
Does anybody else get this sort of mixed message?

I am wondering if she has just read the manual and given you advice that should be given to T1's. Is she new?

I am not a T1 but I remember the lectures when they were introducing the Libre where a presenter was adamant that Hba1c's should not be low since this increased the risk and number of hypo's. This concerned T1's only since being on insulin and trying for low numbers could be counterproductive.

Anyway, I hope that's what happened. If not then you have a rogue DN.

 

[JohnEGreen]

@Dave_Wy first of all welcome to the forum. I would like to add my congratulations on your results well on your way to reversal/remission. I think as @Squire Fulwood says your DN bless her/his cotton socks was giving you advice meant for T1s she really needs to be corrected on this but gently as you do not want the news to be to much of a shock to her/his system.

 

[Dave_Wy]

My nurse is not new. She is near retiring age so I think there is a bit of the old school attitude "We have always done it that way so there is nothing wrong with it". It seems like the one size fits all scenario that we come across in many walks of life.
The NICE guidelines say that if you are lower than the target figure and are not suffering from hypo's and that there are no other underlying problems that you should be encouraged to maintain the lower level . I come from a generation that that believed, trusted and respected the so called experts and always thought that their word was gospel. Fortunately for us there now is a lot of information readily available and although it might not be liked we can now question these decisions that are made for our welfare

 

[Bluetit1802]

She is getting mixed up. 48 is the initial target suggested by NICE for newly diagnosed T2s. It is a target, not compulsory. Well done on your result.

 

[JohnEGreen]

I come from a generation that that believed, trusted and respected the so called experts and always thought that their word was gospel

I'm afraid bitter experience disabused me of that misconception at a relatively young age and then time and time again.

 

[Art Of Flowers]

When my HbA1C was reduced from 99 to 59 I dropped my metformin from two 500Mg a day down to one and when my HbA1C dropped to 44 I stopped it altogether. I will be interested to see what happens next time I have a blood test. I hope it will be as good as before or better. Lower than 48 is a brilliant result.

 

[DavidGrahamJones]

I thought was good results with an Hba1c of 43 only to be told that this was to low and I should be looking for a target of 48.

Only the diabetic nurse can tell you why she's sticking to NICE guidelines with such vigor. In hindsight, asking at the time would be better, but I feel sure the DN would be only too happy to answer your questions, unless she's already getting ready for the knackers yard.

The following document not only confirms what you already know but goes on to mention what should be done for patients with HbA1c lower than the recommended 48 mmol/mol.

http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20080601224005225450

You will notice any dramatic changes in BG when you cut back, if at all, but if you do, then you can go back before waiting 3 months and let them know what's going on. It's always possible that she is concerned that your BG is going low while you sleep, something you wouldn't know about unless you have a CGM like a Libre. Only a thought.

 

[pamK]

Well done you should be so proud of yourself keep up the good work My DN reduced my tablets by half as i have gone done to 36 from 53

 

[Squire Fulwood]

Only the diabetic nurse can tell you why she's sticking to NICE guidelines with such vigor. In hindsight, asking at the time would be better, but I feel sure the DN would be only too happy to answer your questions, unless she's already getting ready for the knackers yard.

The following document not only confirms what you already know but goes on to mention what should be done for patients with HbA1c lower than the recommended 48 mmol/mol.

http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20080601224005225450

You will notice any dramatic changes in BG when you cut back, if at all, but if you do, then you can go back before waiting 3 months and let them know what's going on. It's always possible that she is concerned that your BG is going low while you sleep, something you wouldn't know about unless you have a CGM like a Libre. Only a thought.

The document referenced above says,

"
HbA1c lower than target:

• if adults with type 2 diabetes achieve an HbA1c level that is lower than their target and they are not experiencing hypoglycaemia, encourage them to maintain it. Be aware that there are other possible reasons for a low HbA1c level, for example, deteriorating renal function or sudden weight loss"

This suggests that the 48 (or target) is maximum target and not a minimum one. The way I read it is that if you get lower than target without a problem then well done. There is nothing there that suggests trying to get to at least target or above.

 

[dbr10]

Had my 12 monthly diabetic review with what I thought was good results with an Hba1c of 43 only to be told that this was to low and I should be looking for a target of 48. I do not have hypo's, my weight is good at 9st 7lbs blood pressure and cholesterol are both good. As a result of this I have had my medication of metformin reduced by half with another blood test in 3 months time with what appears to me that the diabetic nurse is looking for worse results!
Does anybody else get this sort of mixed message?

All the time. 43 is fine. You will find that HCPs have very little idea what they are doing, and it is the patients who suffer.

 

[dbr10]

It is absolutely astonishing that there are still doctors/nurses who come out with this sort of rubbish. I'm afraid it just shows a lack of understanding on their part. Why, on this earth, would you want an HbA1c miles above normal or what nature intended? Ideal is low 30's or even high 20's.
You have done very well to get down to 43. Now you should be thinking about what you have done to get this far and then doing a bit more of it. Many Type 2's get their HbA1c's right down to normal or near normal and give up all diabetic meds, the secret is avoiding most carbs/sugars. My husband, James, is one. He completely turned his health round and that was four years ago.
Keep up the good work, your health is more important than keeping diabetes nurses in employment!
Sally

Clearly, we need to maintain non diabetic blood glucose readings as far as possible. The NHS make no attempt to help patients achieve this.

 

[slip]

HbA1c lower than target:

• if adults with type 2 diabetes achieve an HbA1c level that is lower than their target and they are not experiencing hypoglycaemia, encourage them to maintain it. Be aware that there are other possible reasons for a low HbA1c level, for example, deteriorating renal function or sudden weight loss

I'm with the Squire on this one, I bet he/she has just had a refresher training course and learnt T1's hba1c shouldn't be too low - and jumped to the wrong conclusion or as I like to say jumped to the wrong confusion! well done on your 43 and carry on what ever you are doing!

However the quote above got my goat! So this is from a confirmed NICE source? From NICE that also says T2s can't have a Blood glucose meter if they're just taking metformin because it doesn't cause hypos - yet the above statement contradicts the BG meter need ? doesn't it?

 

[Squire Fulwood]

However the quote above got my goat! So this is from a confirmed NICE source? From NICE that also says T2s can't have a Blood glucose meter if they're just taking metformin because it doesn't cause hypos - yet the above statement contradicts the BG meter need ? doesn't it?

Yes it's in the words achieve and maintain. It implies that the patient is joining in the management.

I too have a beef. If the diagnosis happens because a patient has uncontrolled high blood sugar. Why will they only give them a meter if they are in danger of going low.

And ............ if you get type 2 because of your diet (They always say lose weight) then why do they only ask if a blood relative has it? They never say, "Is your non blood related spouse also fat".

I could go on.