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Can hba1c be too low?

Discussion in 'Type 2 Diabetes' started by pavlosn, Dec 15, 2014.

  1. douglas99

    douglas99 I reversed my Type 2 · Well-Known Member

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    I think that's what we're saying.
    There is no exact figure, all I know is the one I have now, is better than the one I had at diagnosis.
     
  2. pavlosn

    pavlosn Type 2 · Well-Known Member

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    My understanding s that doctors in he UK have to follow NICE guidelines or World Health Organisation guidelines not Google anything for an answer.
     
  3. jack412

    jack412 Type 2 · Expert

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    agreed, but we are talking non hypo probably diet controlled healthy T2, he can be 4% there is only normal pop. risk of hypo
    http://guidelines.diabetes.ca/executivesummary/ch8
    [​IMG]
     
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  4. pavlosn

    pavlosn Type 2 · Well-Known Member

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    Jack the very diagram you have put up shows 6% as the lowest hba1c for diabetics, the very advice given by the doctors.
     
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  5. tim2000s

    tim2000s Type 1 · Expert
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    Depends on what google comes back with. 7.5% is one of the values stated as "Optimal Control"...

    The question is, Pavlos,are you happy with the quality of life that you have now knowing that it is limited to some extent by both diabetes and "Life" itself... There is a car outside with your name on it maybe, or a lightening bolt that you'll never know bout, or do you want to push that much harder to achieve a level where the statistical variation in your likelihood of contracting complications is not very far from where you are now, but will come at the cost of the impact on your life now and until the point in time where you die of something other than complications, over which you may have no control...?
     
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  6. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    That's very interesting Jack!

    It's quite a balancing act and as really complicated as I have thought often.
    I think Pavlos is looking for the golden zone!!
     
  7. jack412

    jack412 Type 2 · Expert

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    you with 5.2 and me with 5.4 and all the rest of the T2 under 6 and not having any hopos here..should go and eat sugar to get it up to 6-6.5?..don't think so
     
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  8. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Guru

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    The NICE targets of 6.5% for type 2's not on insulin or other potential hypo-drugs is a MAXIMUM. It is not a minimum or an optimum, and it doesn't give a range.
     
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  9. jack412

    jack412 Type 2 · Expert

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    the ones under 6 are a very unique group that are back into normal non diabetic range,.... we really don't want the death rate of someone with hepatitis C
     
  10. douglas99

    douglas99 I reversed my Type 2 · Well-Known Member

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    Possibly you're missing the point hepatitis C alters HbA1c, so you are making a conclusion that doesn't exist.
     
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  11. jack412

    jack412 Type 2 · Expert

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    not only that but the endo's say that at 6.6 you should be looking for another drug to get it down

    https://www.aace.com/files/aace_algorithm.pdf
     

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  12. pavlosn

    pavlosn Type 2 · Well-Known Member

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    I assure you I have no intention to :).

    Still wonder the advise though.
     
  13. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Guru

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    As I said Pavlos, the NICE advice is a maximum target. It doesn't say what a minimum is. (Correct me if I'm wrong)
     
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  14. NoCrbs4Me

    NoCrbs4Me I reversed my Type 2 · Well-Known Member

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    HbA1c_EMBG.jpg
    The graph is from a 2002 paper that had the objective of defining the relationship between HbA1c and mean plasma glucose levels in type 1 diabetics. There are 1,439 points in the graph. The bottom axis is obviously HbA1c. The vertical graph is mean plasma glucose, which was estimated from seven point capillary blood glucose profiles (premeal, postmeal and bed time). They plotted up the data and obtained a regression line. This study was done before continuous blood glucose monitors were common and before the HbA1c lab test method was standardized, but it was the only plot I found yesterday.

    However, I did find an updated (2012) one today that is less scattered (http://www.medsci.org/v09p0665.htm):

    ijmsv09p0665g03.jpg
    "Figure 3. The A1c-Derived Average Glucose (ADAG) Study Group demonstrated that HbA1c correlates well with average glucose (AG) (R2 = 0.84), however, although 90% of HbA1c concentrations predicted the average measured glucose within ± 15%, significant deviations were observed. The regression equation is: Calculated AG (mg/dL) = 28.7 x HbA1c (%) - 46.7."

    So my HbA1c of 6% could mean an average blood glucose of 7 mmol/L +/- 1 (or from 6 to 8 mmol/L). Or, I could be outside the 90% and it could be very different. You can see from the graph that HbA1cs of 6% correlated to average glucose values of from 100 to 150 mg/L (5.6 to 8.3 mmol/L).

    The more I read about the HbA1c test, the less weight I put on it and the more weight I put on my home blood glucose meter, which isn't all that accurate either.




     
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  15. pavlosn

    pavlosn Type 2 · Well-Known Member

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    This is all I could find in the actual NICE guideline

    http://www.nice.org.uk/guidance/cg8...tyle-managementnon-pharmacological-management

    1.3.1 When setting a target glycated haemoglobin (HbA1c):

    involve the person in decisions about their individual HbA1c target level, which may be above that of 6.5% set for people with type 2 diabetes in general

    encourage the person to maintain their individual target unless the resulting side effects (including hypoglycaemia) or their efforts to achieve this impair their quality of life

    offer therapy (lifestyle and medication) to help achieve and maintain the HbA1c target level

    inform a person with a higher HbA1c that any reduction in HbA1c towards the agreed target is advantageous to future health

    avoid pursuing highly intensive management to levels of less than 6.5%.

    Endquote

    Presumably that last paragraph is a reference to the ACCORD study results.

    Whether "highly intensive management" extents to dietary management as well as medicinal is not expanded on.
     
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  16. pavlosn

    pavlosn Type 2 · Well-Known Member

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    I understand that generally A1c is considered the more reliable test than home testing.

    But as you have shown in the graphs and links you have provided the relationship between A1c and average glucose levels, although well established is one that can only allow you to estimate your average glucose within a certain range for a specific confidence level.

    The main disadvantage of home glucose tests, even setting aside the +/-15% monitor accuracy limitations, are that they are snapshots in time, only giving you a measure of your level at certain specific points in time. Of course with frequent testing you probably end up with several hundreds of these snapshots over time, giving you a better overall picture; but still not a complete picture.

    As you also state in an earlier post hba1c and average glucose levels although related are not the same thing. Hba1c is an indicator of increased risk independently to its relationship to average glucose levels. There are May well be other factors affecting hba1c beyond glucose levels.

    For one two factors that may affect it or even invalidate it is if there is unusual characteristics in ones hemoglobin or if the lifespan of ones blood cells.

    Perhaps using your hba1c count as a means of comparing with earlier counts you may have may be more meaningful than comparing against absolute references but the latter seems to be what the medical profession is doing with diabetes being diagnosed for instance beyond a set predefined hba1c score.
     
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  17. douglas99

    douglas99 I reversed my Type 2 · Well-Known Member

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    I can change my personal reading by several points simply by washing my hands in hot water, exercise, or anything that changes my capillary blood.
     
  18. catherinecherub

    catherinecherub · Guest

    Found this disclaimer from NICE when I was at work.

    Disclaimer

    Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.
     
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  19. jack412

    jack412 Type 2 · Expert

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    it seems they are following the KISS principal ...which may be above that of 6.5% set for people with type 2 diabetes in general
    and it fully explains why there are few under 6%..you get a big pat on the back at 6.5%
     
  20. pavlosn

    pavlosn Type 2 · Well-Known Member

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    I actually had to google "Kiss principle" lol! :)

    My own doctor (not in the UK) seems happy enough for me to be at 5. something percent and has never asked my to increase my levels. But when the matter of reducing meds came up when I was at 5,3% he was happy for me to do so as long as I could maintain a1c below 6,5%
     
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