Better control but higher HBA1C

[Lucie75]

Hope somebody can help as I'm in a bit of a quandry....

I've had trouble with hypo unawareness for a while so I've been running higher to improve my warnings, on the advice of my dsn. She warned me that my HBA1C would increase for the obvious reasons of not being hypo constantly and having bsl generally higher.

My usual HBA1C is between 7.0 and 7.5, and I'm perfectly happy with this. However, just had my latest result at a shocking 8.4. After hypos I'd always rebounded through over-treatment, so although my bsl would be below 4.0 for a lot of the day, I'd also have readings of 16 or 17 a few times a week. I thought these high readings would've pushed my HBA1C up, so seeing as I haven't had the high readings I'm shocked at this result. I expected it to increase a little but not that much.

For me good HBA1C = actual poor control. My control has been so much better these last couple of months, much more stable bsl, hardly any hypos, no rebound readings, warnings improved, but rubbish HBA1C.

What do I do now without risking my warnings disappearing again? Is it better to have a higher HBA1C but good control or the other way round?

 

[kegstore]

Ouch. What a nightmare choice to have to make? It would be an easy one if your hypo warnings had not returned, but since they have and I know you've posted problems with unawareness before, you have to weigh up the pros and cons of each scenario, and only you can do this. Part of it will depend on what your control has been like since diagnosis, do you have any other complications, or first indications of same?

It MIGHT be worth running a higher HbA1c level to keep hypo awareness, but only you can make this decision. How you arrive at your HbA1c level is probably significant too, is it composed of a narrow band of bg control or are there more extremes - some studies suggest that it is the extreme peaks and troughs of blood glucose control that actually do more damage.

EDIT: Just thought of something else, you could try a different insulin and see if you can retain hypo symptoms AND achieve better HbA1c? Works for some, and I've recently done this to try and get some awareness back...?

 

[cugila]

Good advice from Keg.

What you also need to remember is that HbA1c is an indicator of the previous trends for the last three months. Not an indicator of what is happening now. Maybe you shouldn't 'beat yourself up' over this, see what the NEXT one says in another 3 months time.

If you are now well controlled and have got that awareness back I am sure the next result will be much better. Everything will take a little time to filter through.

Ken

 

[DiabeticVeteran]

Hi,

I thought I would add my two pennies worth to your post........

Since very recently, seeing my consultant regarding my problems with losing my awareness, I showed him a whole years worth of BG data for the year of 2008.

He immediatley ssaid that I had lost my awareness BUT stated it wasnot my fault.

He went by saying, some health care nurses & consultants try to aim for the NHS HBA1C blood test readings, which is/was 5%, & he has seen my case scenario in so many T1 Diabetics.

He mentions the continous whipsawing of going low & then high, then stabilising at my target range, then only to drop into the hypo zone. Alot of my reading were in the right zone.
My average readings for the whole of the years was 7.2 mmol/l!
He stated by going by this 5% target, I am running right on the border line of hypos all the time.
I did express my concerns to him that I had mentioned this to my previous consultant/nurses (when i was living in London), but all they suggested was adjust my dosage & have more snacks. Well regarding the snacks, I was eating like a horse & was reducing my dosages as well.

Now that I am on Animal insulin, my BG is better, more constant but as I am under alot of stress at the mo, it is quite hard to control.
From this, he has sdvised me to run my Blood sugars high & aim for a HBA1C reading of around 8 to 9% for 6 months or so, till my domestic issues improve & gain better control & hopefully get my awareness back!

I hope this helps.

Steve