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Can hba1c be too low?

Having followed this thread and posted my own unique experiences. The discussion about which is more reliable or vital in treatment and in the evaluation of data from both.
I have not had my hbA1c taken for nearly two years now.
My consultant didn't see the need as the readings during my fasting 72 never went over 6. And my food diary readings were in the normal range.
My consultant impressed upon me about my own readings from experimenting and testing. I have had a battle to retain my prescription strips as I'm not diabetic!
For me wether the readings are varied because of conditions, it is the here and now that is important.
But, I surmise that because gps don't have imperical personal details of a patient, then a hbA1c is the best way to see how a T2 is fairing with their treatment and diet etc!
 
jack412 said:
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%
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And they deserve a pat on the back when they get down to 6.5.

What percentage do you think we are of the diabetic population, and how much effort have we been prepared to put in to get below that level?
How many diabetics do doctors see that won't put in the effort?
I can't speak for the Australian population, but the UK population doesn't have a good percentage.
 
6.5% seems to be a trigger where action needs to be taken to reduce BG
 
NoCrbs4Me said:
What do you mean by "points"? Surely you don't mean, say, a change from 5 to 8?
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I mean from say 8 to 5.
5 to 8, I could probably do with a couple of donuts.
 
douglas99 said:
I mean from say 8 to 5.
5 to 8, I could probably do with a couple of donuts.
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Why would you want to?
Why make yourself Ill?
Surely your testing should involve washing beforehand all the time, it must be regimented or you wouldn't have an idea how you are doing?
 
I mean if I test, I can easily move my BG reading from 8, to 5.
I think it's simply flushing the 'stale' blood from my capillaries.
If I sit, I can have a high reading, but if I open up my capillaries, by exercise, or by a bit of warmth, I can push core blood to my skin, and it always lowers the reading.

For the record, I don't try to push my BG from 5 to 8 by eating donuts.
Having said that, a spike of 8, I doubt would make me ill, and I could probably burn it off fairly quickly.
The problem is, as it was a flippant remark, I suspect I may actually only need maybe one, or less, so I won't be trying it yet.
 

"DIABETES: FACTS AND STATSPART FOUR: DIABETES CARE

Only 20.8% of all people with diabetes are achieving the targets recommended to reduce their risk of developing diabetes complications.In Type 1 diabetes this is only 11.8% and 21.5% in Type 2, so despite many people being tested for blood pressure, cholesterol and HbA1c, relatively few are then achieving the targets they should.

Achieving target:

- HbA1c below 6.5%: 6,5% of type 1 and 26.2% of type 2s

- Cholesterol below 4mmol/l: 29.7% of t1s and 41.3% of t2s

- BP below 140/80: 57.9% of t1s and 47.3% of type 2s
These figures have not changed significantly over the last three years."

http://www.diabetes.org.uk/Documents/About Us/Statistics/Diabetes-key-stats-guidelines-April2014.pdf

The above percentages are quite shocking.@jack412

Pavlos
 
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So is it ignorance of the consequences, due to lack of eduction from the HCP's?
Refusal to accept the facts by the diabetics?
Just too hard to make the changes?

This is why the targets are 'high', it's simply because it has to be a realistically achievable figure.
So 6.5 is achievable, and will make a difference.
And a percentage will achieve it.

Then, the question is, what's the next step?
I had good support from my HCP's.
I did the first stage, they helped me on to the second stage.
So, like diabetes, the help is also progressive, and geared up to the patients desire to achieve sustainable results.

I don't know if I would have seen the end, if it was presented as one massive step.
 
Two sides to every coin Douglas.

@jack412 will probably say that it shows that the healthy plate diet promoted by the NHS is flawed and should be replaced with LCHF.

Please let us not get into that argument though
 
NoCrbs4Me said:
Mine doesn't change that much in a typical week.
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Did you get a chance to discuss the inconsistency between your A1c score and monitor average counts with your doctor?

Could you be having glucose peaks after the two hour point because of the high fat element in your diet lowering effective GI? Do you ever test beyond two hours after meals?
 
pavlosn said:
Two sides to every coin Douglas.

@jack412 will probably say that it shows that the healthy plate diet promoted by the NHS is flawed and should be replaced with LCHF.

Please let us not get into that argument though
Click to expand...

Again though, would many take that diet as a simple first step?
 
NoCrbs4Me said:
Mine doesn't change that much in a typical week.
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I know mine does.But I chase the highs on my meter, so I never bother to see the lows normally.
That ties into my HbA1c of 34.4. Very brief highs, normally within my personal limits, then back down, and also a fasting level of low 5's. So stable overall to give me my HbA1c
 
The few type 2's I know don't follow a low carb diet. They eat what they like from the Healthy Plate. They even have cakes and biscuits, albeit not every day. They rely on meds and expect the meds to help because the doctors tell them they will. They are told well done if they are under 53 (7%). This is the initial target at our practice. I was only 53 when diagnosed, so I wasn't given a target. When the meds don't help and their HbA1c goes up they are given more meds and told it is progressive and inevitable. They genuinely haven't a clue they are doing anything wrong.
 

Do they change when you tell them?
 
douglas99 said:
Do they change when you tell them?
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No. They prefer to believe the doctor. Maybe because they are afraid of reducing carbs and doing without favourite foods. They do exercise though, and haven't much weight to lose. I honestly believe they genuinely think they are in control.
 
No, and I don't think I will. She is really clueless about diabetes. It wasn't a proper lab test any, just a portable tester at the chemist. Not sure I believe the result. I'll get a proper lab test done next month.

Generally I don't test much these days, but I will after a carby meal. However, I did spend a 24 hour period testing frequently (20+ measurements) a couple of weeks ago while eating my typical low carb meals. The average for the day was around 5.6 mmol/L and nothing above 6.8, if I recall correctly. There was an odd double peak between breakfast (coffee, bacon and eggs) and lunch. I've since started having just a coffee for breakfast.
 
Bluetit1802 said:
...........................Maybe because they are afraid of reducing carbs and doing without favourite foods. ................................
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That's the dilemma. I suspect the doctor has a fine line of scaring them off entirely, or doing the best the can with patients that aren't as focussed as we are.
 
Education is always the best remedy. If and I know thats why we have courses, they had the time GPs would no doubt have a different approach!
The NHS doesn't have the resources to treat diabetes the way we would want it to be!
 
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