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Changes in hb1ac : why the variance?

HSSS

Expert
Messages
7,675
Location
South of England
Type of diabetes
Type 2
Treatment type
Diet only
having just read another thread where people were talking about very high initial hb1ac and how far they reduced them in just 3 months I’m wondering what accounts for the difference. For example on no meds I’ve been down to max 40g carbs per day been consistently in ketosis lost 2 stone and mine went from 54 to 44. More than a few have gone from nearly double my starting point to lower than me also with no meds and often higher carbs. Exercise not much mentioned. I do some but not a huge amount

I know we’re all individuals and I’m trying hard to maintain my pleasure at my progress. But what things make that difference? Is it the degree of insulin resistance we each have? The exercise factor? How long we’ve had it? Other conditions? General health? Ideas and theories welcome. Actual facts even more so.
 
I can only speak for myself as we are all different. Before DX I was drinking gallons of coke. I couldn't eat enough salt and vinegar chipsticks, neither of which I had touched in at least 30 years. At DX I immediately went low carb. I ditched potatoes, bread, rice, pasta etc. Ok, I made a few mistakes along the way.

My decreasing numbers coincided with going on the highest dose of Metformin and getting a handle on the LCHF diet.

I tried to keep my carbs under 20 carbs per day.
 
Some people liken falling A1c to weight loss, the more weight you have to lose then the faster the fall (this is in very general terms, of course) but the weight loss eventually slows down and sometimes there's that last stubborn half stone that comes off but ever so maddeningly slowly.

Edited to add.

So, the average life of a cell is 8-12 weeks let's say you're A1c Is very high indicating high numbers of glycated cells, if you are low carbing then as newer cells (all shiny and red) enter older (glycated) cells die and are disposed of.
 
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For me it was intermittent fasting combined with less than 20g carbs a day. I do (a lot of) exercise, but that’s more about fitness and mood than weight or BG. A period where I added regular (2 to 3 times a week, sometimes an extended run of 14 consecutive days) of eating one meal a day (dinner) really accelerated both weight loss and decline in BG levels.

Suspect that those (like me) diagnosed with very high numbers have been diabetic for many years before being diagnosed and have high insulin resistance, so no theories from me other than the lower in carbs you can go and the less you trigger your body’s insulin response through eating, the better: I only have to have a couple of days of eating more (quantity) to start seeing BG rise slightly: past 2 days ate 21g and 15g carbs but significantly more in quantity and daily average has increased, not by much at all, but shows impact.
 
I never thought about weight loss but it was a pleasant surprise when I found I had lost 13kg without noticing.

My aim was to keep the daily average sugar level low and I found that walking lowered it rapidly. For some years I walked 3km a day. I live next to beautiful woodland so it wasn't a chore. I didn't have to walk that far to get results. The first 15 minutes or so was the most significant.

During that time I had problems with Metformin so stopped taking it a couple of times. This had absolutely no effect on my blood sugars. Diet and walking had a major effect. I stopped taking Metformin completely since the side effects were not worth the lack of help in blood sugar control.
 
One thing to consider is that you may not be T2. I spent over 4 years as a 'T2' on no medication. My HbA1cs hovered in the 40s and 50s until I got ill, lost weight, and registered an HbA1c of 102. Following a trip to the Diabetes Clinic I was diagnosed as LADA and put on an insulin regime.
Whilst I was still 'T2' I felt that puzzlement that other T2s were getting better results than me even though I was lowcarbing..
It seems now it was a case of :
Want an HbA1c in the 30s ? Pancreas says no !
So don't rule out slow-onset T1.
Geoff
 
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It has taken me three years to get from an HbA1C of 108 to 49. I was not obviously fat when I was diagnosed. However, I did have a curiously ill-defined "six pack" right over my ribs. Unable to kid myself that this was anything other than a hard pad of fat, with probably a lot more of it aruond my organs, I have set about changing my eating habits, increase exercise and to reduce my BMI to its safe lower limit (not there yet). Of course my many slips along the way have delayed my HbA1C improvments but there is no doubt in my mind that a lot of the trouble in reducing BG is middle "hidden" fat. Here is a paper that backs up this view.

Changes in Body Fat Distribution and Fitness Are Associated With Changes in Hemoglobin A1c After 9 Months of Exercise Training

Results from the HART-D study

SÉNÉCHAL M, SWIFT D et al

DIABETES CARE, VOLUME 36, SEPTEMBER 2013
 
HSSS said:
I know we’re all individuals
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You might have answered your own question. I've gained and lost 8 stone since diagnosis, but the game changer for me has to be the low carbohydrate diet, just by removing bread, pasta, rice, potato, that's about 800 calories (1/3 of RMR) and about 200 gms of carbohydrate, so down to < 50gms most days. Lower blood glucose came within weeks of going low carb and in fact allowed me to throw away Gliclazide and Januvia, lower cholesterol gave me the confidence to throw the statins away as well.

Recently I have had to be very careful of protein because that seems to be behind some BG spikes I've had recently.

HSSS said:
Is it the degree of insulin resistance we each have? The exercise factor? How long we’ve had it? Other conditions? General health?
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Yes, yes, yes, yes (e.g. stress) and yes (e.g. colds, flu etc)
 
There seems to be no rhyme nor reason why some people are able achieve a very low HbA1c @HSSS . I was not particular high at HbA1c 67 when diagnosed and was 77kg and 5'7". I went low carb immediately and within 3 months I had lost 18 kg and my HbA1c was 40. In the intervening 2.5 years I have lost another couple of kilos but really can't afford to loose anymore as skinny as a rake with no tummy whatsoever. However, my HbA1c has never dropped below 39. It does not matter what I do, exercise more, cut carbs further, drink more water, nothing shifts my HbA1c lower. I have had to accept this is where my body wants to be!

I think a lot of messed up metabolism is down to liver function and although my liver function test are all good I think it is still messing with my metabolism. I took some very strong prescribed drugs in my twenties to curb an acne problem and this particular drug is known to mess considerably with the liver. I guess I will never know but continue rigorously with low carb and hope that over the years my HbA1c does not start to creep up!
 
Maybe the initial huge drop people report after 3 months could relate to how many less carbs they are eating from before diagnosis rather than the actual number they now eat. Two people, both now eating 40g carbs, may have different drop rates if one was eating 500g carbs before and the other only eating 200g.

Also, if your red blood cells are long livers, in 3 months there will still be a lot of old ones still alive, and not as many clean new ones.
 
CoastGirl said:
skinny as a rake with no tummy whatsoever. However, my HbA1c has never dropped below 39. It does not matter what I do, exercise more, cut carbs further, drink more water, nothing shifts my HbA1c lower
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This is my experience too, except my A1c is stuck at 38 despite my eating well under 20g carbs daily.
 
There’s nothing wrong with 38/39. I’m actually delighted that I have achieved it!
 
I average about 100 carbs per day which is more than many on here but have maintained my hba1c between 34 and 37 for about 4 years.
 
In preparing for a trip to my GP recently, I thought I should prepare to explain why my HbA1C has been drifting upwards (still less than 40).
The main factor is low red blood cells, which has a direct effect. I have always been low, about 10% less than the standard range, but the doc always says it's normal for me. However, fewer cells floating around in the blood stream are likely to get a thicker coating of glucose.
Another factor is illness, I have had another bout of shingles.
And to cap it all, I am back on a low dose of Atorvastatin (10mg), a compromise between the GP, me and my wife. Statins increase blood glucose and can even be associated with leading to T2 in the first place.
I was all set, but the subject didn't arise during the appointment, which is fine as I didn't need any input.
But my point is that many things can affect the changes in HbA1C, so not to get too focussed on numbers.
 
Concordjan said:
There’s nothing wrong with 38/39. I’m actually delighted that I have achieved it!
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It all depends what level you have come from and what target you have chosen. My worst A1c was 41. Even by cutting almost all carbs from my diet I can't get it any lower than 38. I would dearly like a "normal" A1c of 31, or failing that 34 max. According to research quoted by Jenny Ruhl, heart attack risk rises with the rise in A1c above 31, slowly at first, but then more steeply from 36 upwards. My family is prone to cardiac problems, so I am wary of that risk.
 
It's not the cells that get coated, but the hemoglobin molecules within the cells that get glucose molecules attached. Note that each red blood cell contains about 270,000,000 hemoglobin molecules. The HbA1c measurement gives the fraction of glycated hemoglobin molecules that are glycated so it would not be affected by the actual number of cells. On the other hand, if the average lifetime of your red blood cells differs greatly from the normal, this does result in erroneous HbA1c readings. I don't know if the average lifetime of red blood cells in an individual can vary or is fixed for life.
 
Thanks, I didn't understand the mechanics. But if there are fewer red blood cells, might that also mean that a bigger proportion would be glycated? Also, fewer red blood cells may be because they don't live very long or aren't being produced in sufficient quantities. I have been anaemic for over 60 years, so there is something fundamental at work.
It is all very difficult and I was just saying not to concentrate too much on the numbers. My fbg is pretty constant at 4.5 and my weight is on target which are my main priorities.
 
Thanks all. Some good thoughts and some particularly resonated with me. I find it fascinating understanding how it all works and interacts. Always loved “anat and phys”

Do you know what test measures the number of hb molecules on each cell? Is it one of the standard ones? i see lots of different red cell/hb measures on my fbc and not sure what they all refer to. Some are out there on the edges of range.
 
The glucose that you are measuring with fbg is in the blood plasma not the cells, so not really affected by your anemia. If I had a fbg of 4.5 I wouldn't be the least bit concerned about HbA1c I would just be rather smug.
 
I believe that Mean Corpuscular Hemoglobin is the weight in picograms of the hemoglobin in a red cell. Fortunately all my blood numbers are in range so I haven't investigated what they all mean, how they interact or what is important, you would need to consult your GP.
 
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