1. Get the Diabetes Forum App for your phone - available on iOS and Android.
    Dismiss Notice
  2. Guest, we'd love to know what you think about the forum! Take the Diabetes Forum Survey 2020 »
    Dismiss Notice
  3. Diabetes Forum should not be used in an emergency and does not replace your healthcare professional relationship. Posts can be seen by the public.
    Dismiss Notice
  4. Guest, stay home, stay safe, save the NHS. Stay up to date with information about keeping yourself and people around you safe here and GOV.UK: Coronavirus (COVID-19). Think you have symptoms? NHS 111 service is available here.
    Dismiss Notice
Dismiss Notice
Find support, ask questions and share your experiences. Join the community »

Can hba1c be too low?

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

  1. pavlosn

    pavlosn Type 2 · Well-Known Member

    Messages:
    2,705
    Likes Received:
    8,706
    Trophy Points:
    178
    @jack412

    This is a link to the full study from which the above numbers were extracted:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27454/

    The study concluded that the lowest risk is associated with normal hba1c of 6% or lower ( median value 5,6%)

    Unfortunately, it uses less than 6% as the lowest statistical band examined and as far as I can see it does not answer the issue of risk associated with sub 5% hba1c.

    You are right in saying that it supports reducing further than 6%
     
  2. Susiespearish

    Susiespearish Type 2 · Well-Known Member

    Messages:
    358
    Likes Received:
    449
    Trophy Points:
    103
    I posted on thIs subject a short while ago .My HbA1c has never reflected by daily BG numbers .I had never had a reading in sin gle figures ever since I got the machine yet previous HbA1c's registered as 86.It has slowly caught up and is now registering as 109 but it's accuracy is certainly in question to base a drug regime on .I now take my meter to every consult .
     
    • Like Like x 2
  3. NoCrbs4Me

    NoCrbs4Me I reversed my Type 2 · Well-Known Member

    Messages:
    3,700
    Likes Received:
    9,090
    Trophy Points:
    198
    You are very confusing. You disagree with my statement, yet, to control your blood glucose levels you intentionally don't follow the official government recommended diet. I give up.
     
    • Like Like x 2
  4. pavlosn

    pavlosn Type 2 · Well-Known Member

    Messages:
    2,705
    Likes Received:
    8,706
    Trophy Points:
    178
    Guys can we leave the subject of diets out of this thread please and return to the original issue which is Hba1c and whether it can be too low.

    Thank you for your cooperation

    Pavlos
     
    • Like Like x 4
  5. pavlosn

    pavlosn Type 2 · Well-Known Member

    Messages:
    2,705
    Likes Received:
    8,706
    Trophy Points:
    178
    An hba1c of 86 is equivalent to average blood sugars of 13,3 while 109 corresponds to average glucose of 16,7. You do not necessarily need single figure readings to get these kind of averages. Having said that you know your numbers best and if you think your Hba1c score is not in line with your averages I will not dispute it.

    It is known that some people may renew their blood cells faster than the three month average. For these people hba1c understates their true glucose average because their blood cells are new and the glucose has not had enough time to attach to them.

    Unusual hemoglobin may be another reason for discrepancies.
     
    • Like Like x 2
  6. Susiespearish

    Susiespearish Type 2 · Well-Known Member

    Messages:
    358
    Likes Received:
    449
    Trophy Points:
    103
    Pavlos .I was consistently getting readings in the 20's for weeks which weren't reflected in the test .Luckily with my meter in tow I was able to show them the readings .On the main subject of how low is healthy.I was told last week by my Endo that I should never go below 6 and in fact the target he's set me is for 7.5 although I do have a heart condition and high BP .My husband who is a non diabetic (tested) throws highs of 9 and 11's regularly but normally has a fasting average of around 5.4/6 on a daily basis .
     
  7. daddys1

    daddys1 Type 2 · Well-Known Member

    Messages:
    1,353
    Likes Received:
    3,954
    Trophy Points:
    178
    Hi Kezzer, I feel the same , I was diagnosed Pre Diabetic some 9 months before being diagnosed fully Type 2 but no one mentioned how serious this was until full diagnosis, Yes I went off to lose weight but was not encouraged to look up diabetes given no information, just told "lose some weight you will be OK". I started eating fruit, didn't do that before, had less fat and to top it all had Majool Dates, one of the most sugary fruits you can mention, at least 4 a day for over 9 months thinking I was doing myself good.

    When I got the Big 'D' diagnosis, I could not believe how stupid I had been, but no one had even mentioned what I should have been doing.

    Neil
     
    • Like Like x 4
    #107 daddys1, Dec 17, 2014 at 12:02 AM
    Last edited by a moderator: Dec 17, 2014
  8. douglas99

    douglas99 I reversed my Type 2 · Well-Known Member

    Messages:
    4,572
    Likes Received:
    3,763
    Trophy Points:
    178
    It states the normal range is 4.5 to 6.2, but the only conclusion it seems to suggest is that the normal range is best, ie less than 6, as far as I can understand the report.
     
    • Like Like x 4
  9. pavlosn

    pavlosn Type 2 · Well-Known Member

    Messages:
    2,705
    Likes Received:
    8,706
    Trophy Points:
    178
    The guidelines do state that the target hba1c should be set by the doctor in consultation with the patient and after taking into consideration the patient's individual circumstances.

    Did your doctor give you a reason for asking you to stay above 6 ( is that fasting level?)

    Are you on medication that could cause you to go hypo for instance such as insulin or gliclazide?
     
  10. pavlosn

    pavlosn Type 2 · Well-Known Member

    Messages:
    2,705
    Likes Received:
    8,706
    Trophy Points:
    178
    It also states that the median hba1c within the normal range is 5,6% but you are right it just groups all normal range Hba1c scores together and does not examine any subgroups within that.
     
    • Like Like x 2
  11. douglas99

    douglas99 I reversed my Type 2 · Well-Known Member

    Messages:
    4,572
    Likes Received:
    3,763
    Trophy Points:
    178
    I missed that.
    If the median is 5.6, of a range of 4.5 to 6.2, it would be a skewed distribution anyway, as the mean is 5.35.
     
  12. Susiespearish

    Susiespearish Type 2 · Well-Known Member

    Messages:
    358
    Likes Received:
    449
    Trophy Points:
    103
    Yes Pavlos,this was in a discussion before I commence insulin and a higher dose of Sitagliptin.My consultant was also involved in a recent study quoted by @smidge stating the increased risks of of cardiac events when on insulin so with my present heart condition and a great deal of meds for that I can only assume he's worried about that .Our target is 7.5 .Thank you for posting the graphs and data .It has made interesting reading .:)
     
    • Like Like x 2
  13. douglas99

    douglas99 I reversed my Type 2 · Well-Known Member

    Messages:
    4,572
    Likes Received:
    3,763
    Trophy Points:
    178
    There's something new learnt everyday with diabetes.
    I suppose it's always going to be a fine line balancing everything in the right place.
    You sound like you've got an excellent consultant though.
     
    • Like Like x 3
  14. LucySW

    LucySW Type 1 · Well-Known Member

    Messages:
    1,915
    Likes Received:
    2,810
    Trophy Points:
    198
    But it isn't an average. That's the point. It's an amount that increases incrementally as additional hemoglobin particles are glycosylated. Hypos don't cut HbA1c, or even show up in HbA1c numbers at all.
     
    #114 LucySW, Dec 17, 2014 at 10:41 AM
    Last edited by a moderator: Dec 17, 2014
  15. LucySW

    LucySW Type 1 · Well-Known Member

    Messages:
    1,915
    Likes Received:
    2,810
    Trophy Points:
    198
    Pavlos,,

    Have a look at Jenny Ruhl's summary of the latest findings from the ACCORD study. That's the one that seemed to associate lower HbA1cs with increased mortality.

    http://diabetesupdate.blogspot.dk/2014/12/accord-final-analysis-lowering-blood.html?m=1
     
  16. LucySW

    LucySW Type 1 · Well-Known Member

    Messages:
    1,915
    Likes Received:
    2,810
    Trophy Points:
    198
    Hypos don't affect HbA1cs. They don't show up in them. HbA1cs are a cumulative measure that can't be lowered at all by anything. They can only not be raised in the first place.

    When they go down it's because the Hb cells/molecules have died.
     
  17. pavlosn

    pavlosn Type 2 · Well-Known Member

    Messages:
    2,705
    Likes Received:
    8,706
    Trophy Points:
    178
    Can you please explain this further or provide a relevant link.

    As I currently understand it hba1c ( in % terms at least) is a measure of the proportion of our hemoglobin that has been glycated I.e has a glucose particle attached.

    The rate at which hemoglobin is glycated and hence Hba1c depends on the concentration of glucose in the blood. The higher concentration of glucose the higher the rate at which hemoglobin will be glycated and the higher the Hba1c.

    A hypo is a period when our glucose concentration although lower than normal is still positive, not negative.

    During a hypo I would expect hemoglobin to continue to be glycated but at a slower rate (assuming that there is no minimum glucose threshold for glycation to occur).

    So a hypo, being lower than our average glucose count, will cause our average to decrease, while actually still causing hemoglobin to be glycated (albeit at a lower rate), so still contributing to increased hba1c.

    The complication is that our blood cells are continuously being renewed (on average every three months) so theoretically if the rate of increase of glycated cells slows down beyond the rate at which the glycated cells are replaced with fresh ones, then hypos would cause the proportion of glycated hemoglobin and hence hbA1c to decrease. I do not know if this is a practical possibility though.
     
    • Like Like x 2
    #117 pavlosn, Dec 17, 2014 at 11:00 AM
    Last edited by a moderator: Dec 17, 2014
  18. sanguine

    sanguine Type 2 · Well-Known Member

    Messages:
    3,341
    Likes Received:
    9,637
    Trophy Points:
    178
    I think you're both right. Rate of glycation (or whatever the word is) will depend on the BG level in the blood. This acts on the positive side of the HbA1c balance. The negative side is when glycated blood cells die and are replaced by new blood cells, but the haemoglobin cells can't be 'deglycated' when still viable. The longevity of blood cells varies and is a subject in itself, but as a rule of thumb we assume it to be around 2-3 months.

    As for hypos, I would expect glycation to still be occurring at a reduced rate as Pavlos says (we may be wrong on this) but unless you have them frequently and for long periods I can't see that it would have much affect on the HbA1c any more than an occasional spiky meal would.
     
    • Like Like x 3
  19. LucySW

    LucySW Type 1 · Well-Known Member

    Messages:
    1,915
    Likes Received:
    2,810
    Trophy Points:
    198
    My understanding is that the rate of hemoglobin glycation will be lower not only during hypos, but whenever blood glucose levels are low to normal. That is, the rate will be a curve, not a line. So it will accelerate gradually, rather than going from hypo level in a straight line up to high blood glucose levels.

    So the factor determining low HbA1c would be the total amount of time spent with blood glucose levels below a certain threshold, the threshold at which for each individual at any given time the rate of glycation increases. Which is a circular definition of course.

    I shall have to go away and do some work on this.
     
    • Like Like x 2
    #119 LucySW, Dec 17, 2014 at 11:16 AM
    Last edited by a moderator: Dec 17, 2014
  20. Squire Fulwood

    Squire Fulwood Type 2 · Expert

    Messages:
    6,058
    Likes Received:
    4,819
    Trophy Points:
    178
    Please come back and teach us what you find out ............and don't call me Ducks. (Just a little joke).
     
    • Like Like x 2
  • Meet the Community

    Find support, connect with others, ask questions and share your experiences with people with diabetes, their carers and family.

    Did you know: 7 out of 10 people improve their understanding of diabetes within 6 months of being a Diabetes Forum member. Get the Diabetes Forum App and stay connected on iOS and Android

    Grab the app!
  • Tweet with us

  • Like us on Facebook