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'Correct' HBA1c

J

jameshallam

Well-Known Member
Messages
109
Hi all,

Had my first check in with the consultant yesterday and my reading was 6%. (Incidentally I used an online tool to estimate it from my BG readings and it estimated it at 5.97% - pretty close!).

The consultant said this was very good, and after discussing many things I asked this:

1. What should a HBAc1 be in a 'normal' person - <5.4

2. If a non-diabetic person and a diabetic (I am T1) both had a reading of 5.4, does the diabetic person still have a higher risk of 'complications' (due to high BG) in later life? - No, but a level of 5.4 is unattainable in the long term for someone with diabetes - without losing hypo awareness...

Just wondering what people on here thought about this opinion. I notice a lot of people on these boards strive for and attain HBA1c's in the 5s...

The consultant said I should be aiming for a level of 6.5 - but anywhere between 6-7% is good.

Cheers,
James
 
Re: 'Correct' HBAC1

James
Your consultant gave you an incorrect number. In a survey done by a meter manufacturer( they repeat this once in a while) the AVERAGE HbA1c of non-diabetics is 5.1% and this includes people who "run high ", which is pretty common. Bernstein is now of the belief that 4.2% may be the ideal figure. He's brought that down from his previous idea of 4.6%
Doctors don't often look up new data. They go on what they read years ago.
This is why they set targets so high
Yes 5.4% is attainable. there are many diabetics who keep in that range. Again read Bernstein.
Why should 7% be ok? even NICE and DUK have brought their targets down to <6.5%. If Ideal is 4.2 or even4.6%, 7% is significantly higher.
I'm a 5% club member and due my next test soon. I hope it hasn't gone up, but I've had a couple of bouts of infection recently, which have pushed the BG up.

Hana
 
Which book by Dr Bernstein should I be reading? I am interested to learn more about diabetes - can even show it to my consultant next time I see him!

To achieve a HbA1c below 5% would require BG readings of around 5 almost all the time (correct?).

I do aim for readings in the 5s, but if I am driving or playing sport then I aim higher than this. And of course sometimes my BG is higher than I would like for a variety of reasons.

Therefore to 'balance it out' I would then have to have some readings below 5, at which point you get to dangerous ground if you start going too low.

His point (I think) was that if I had a HbA1c of below 6% - he would assume I would have to be having hypos. Which I agree isn't good for anyone's health...

Do people (with HbA1C's in the 5s) often have hypos? If so how often, and how severe?

I had quite a few (about one a day) when I was getting used to my carb ratio. But I felt them all coming on (shakey hand), and I was testing all the time. Only one (2.7) was below 3 - so not dangerously low (I could deal with them all on my own).

My last hypo was last year after a particularly vigorous game of badminton which went on longer than I expected.

I think I have rambled for long enough!
Cheers,
James
 
Re: 'Correct' HBAC1

James your consultant is correct in what he is saying...
The problem with HbA1c’s is that it’s very difficult to say what is a good HbA1c, more so when talking in the T1 context. As it’s not quite as simple as saying the higher the number the worse control one has... This is because the HbA1c is an average over a period of time, so for every hypo one has it will shave off the higher readings which can lead to an T1 having an excellent HbA1c, but in reality day to day the most awful control going...
Over the years there have been a lot of studies, and reviewing of information concerning control and HbA1c numbers to aim for... These have been based taking several factors into consideration
Risk factors of higher levels
Realistic achievability of individual of tight control
Safety factors;
The likely hood of hypo’s from serious to mild
The loss of hypo unawareness

You will find that a lot of individuals that claim to achieve the 5% are actually Type2 diabetics which is a different ball game than being T1 and using insulin... The few T1 diabetics you will find suffer hypo unawareness that will have a big impact daily lifes, such as preventing them from driving

As to hanna suggestion well, meter manufactures do not use the information they collect to advice diabetics how to control their diabetes, but as a source of information to test out accuracy of their meters, after all every meter only needs to fall into a 20%+/- accuracy rate!!!
And as to Bernstein, well he’s an American doctor, he’s isn’t a specialist nor a consultant but a doctor who mainly deal with diabetics, he has many theories, most not independently researched nor actually researched by himself, but promoted to underpin his theory and book sales of his ideology of diabetic control.. It is how ever worth a search to find his Forum and take a read through, as you will find that those who decide to follow his ideology do struggle as much as any diabetic..
In reality for T1’s, it’s better to look at day to day control, achieve tight control here where you avoid hypo’s and hypers, maintaining hypo awareness you tend to find that the HbA1c looks after itself... It is far better to have a tightly controlled HbA1c of 6.5%, than an HbA1c of 5% that has been achieved by suffering many hypo’s, losing one’s hypo awareness etc..
 
I would love to have a HbA1c of 4.2, but as a T1 it's not going to happen, that's kind of the point of having diabetes - the mechanism that makes such tight control possible is knackered. End of story.

From the perspective of a T1, we can try as hard as we like to get to achieve this "magic number", but the closer you get to it, so the risk of hypoglycaemia increases to a very great extent. Even a pump doesn't permit such fine control - it's only doing what it's told to and will continue to deliver the insulin it's been programmed to, regardless of blood sugar levels.
 
You have to remember, HbA1c is an average.

Years ago I was on insulin that disagreed with me big-time. I had v.poor quality of life - sudden, severe hypos, memory problems, persistent weight loss, violent temper, generally not a nice person to be with. Had to stop learning to drive and couldn't hold down a job. But my HbA1c was between 6.5 and 7 (the average of many swings between the extremes) which at the time was considered "good control" so the DSNs dismissed my problems. I would not call my life at that time "controlled"! Switched back to pork insulin and the major problems went, HbA1c was higher but life much better.

Finally got things properly sorted 3 yrs ago on DAFNE - HbA1c stable at 6.6 with none of the previous problems. I aim to reduce it but recognise there will be a limit for me, with ratios and basal needs that vary from week to week and a history of sleeping through night hypos.

If your readings are stable and predictable overall and you have good hypo awareness then it would be safer to reduce HbA1c - not so if you have more variable/unpredictable readings. There is more to it than purely low numbers and in many ways stability is more desirable.
 
Hi James, your consultant is not wrong and for anyone to say he is wrong is just daft!

I was running my Hba1C at below 6 and suffering from lots of hypo's (with warning signals I might add!and I cranked it up a notch to just over 6 and I feel so much better! Never mind what someone says in a book, that is real time advice from a real person who is real. Have I made my point?!

Ok, so not all books are bad and of course we should read and learn and take note. but bottom line, for a type 1 with an Hba1c of 6, you're doing pretty darn well! :D :P :wink:
 
Hi, I have to agree with some of the previous posts. It's all about achieving stable readings and balancing this with your quality of life. I have 2 young children with type 1 and they normally have similar HBA1c's, although my sons daily readings fluctuate far more than my daughters. Because it's an average it doesn't look at the bigger picture. The hospital always congratulate me on their control, but it's the daily readings which I tend to focus on. Another factor my husband and I always consider is their control over night. Since they tend to sleep 11- 12 hours, getting good overnight control plays a vital role in their average readings, although the daytime readings would tell a different story.
 
Bernstein.....I read somewhere that this 'expert' is totally hypo unaware and he has been for years. I shall have to try and dig out the link if I can.
 
kegstore said:
I would love to have a HbA1c of 4.2, but as a T1 it's not going to happen, that's kind of the point of having diabetes - the mechanism that makes such tight control possible is knackered. End of story.
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Keg, that is one of the best posts I've ever read on this forum! :lol: 8) Short, sweet, too the point and 100% accurate - Good on you! :wink:
 
LittleSue said:
If your readings are stable and predictable overall and you have good hypo awareness then it would be safer to reduce HbA1c - not so if you have more variable/unpredictable readings. There is more to it than purely low numbers and in many ways stability is more desirable.
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Well said LitleSue!

Stability is the key, no good running the risk of persistant hypo's for the sake of lowering your Hba1c by 0.5 or 1%. Sometimes it just isn't worth it!

Regards

Nigel
 
Debloubed said:
Ok, so not all books are bad and of course we should read and learn and take note. but bottom line, for a type 1 with an Hba1c of 6, you're doing pretty darn well! :D :P :wink:
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I agree with you 100% Debloubed!

Although my last hba1c was 6.7, I am looking to lowering it slightly to around 6 and maintain this figure. Should I achieve this, I will be more than happy, believe me......more than happy!

My early years were not good, hba1c's of 10+, only in the last 15 years has it come down slowly, the last few years between 7.5-8.7%. As I say, last one 6.7, better than the previous of 7.1, so getting their slowly.

Regards

Nigel
 
Thanks guys - my questions have been answered!

I'm pretty happy where my HbA1c is at the moment and I think if anything it will reduce as I get better at counting carbs and matching my insulin.

Good point about the night time BG level - that almost equates to half the time...
 
jameshallam said:
...Incidentally I used an online tool to estimate it from my BG readings and it estimated it at 5.97% - pretty close!...
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Out of interest, which online tool did you use James, as I've just tried one that estimates my HBA1c at 5.45%.

I don't know if the estimation site I used is reliable, but If the real result is anything like that I shall be one very happy bunny (as it was 9.7% in November, on diagnosis).
 
I agree with your doctor and I have been there.
5.4% represents an average blood glucose level of 6mmol. This would mean having a pre prandial level of 5 and a post prandial level of 7mmol; As for an Hba1c of 4.2% this represents an average level of only 4.1mmol !
My lowest HbA1c was 4.9%, at the time I was training for a marathon, however I had daily, sometimes several times daily hypos. Although my hypos were very easily treated and I appeared to be able to function well, I wasn't recognising them until I was in the low 2's. I was not bouncing from high to low as I was also careful about carb counting and had good control over postprandial levels but the lows were too frequent and too low. I don't live in the UK and fortunately my doc felt that I would benefit from a pump.
Using a pump, I've had fewer hypos and better awareness. My last HbA1c was 5.7%. If I didn't exercise so much I have no doubt that my levels would be a few points higher.

As to normal HbA1cs being down in the low 4s. David Mendosa cites research by the National Glycohemoglobin Standardization Program (a lab thats involved in regulating International standards) who test a sample of non diabetics every few years.

So what were their levels? They ranged from 4.5 to 6, Curt replied. That's at plus or minus 3 standard deviations
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He also said that
levels below 4.5 are "quite unusual," and usually are only when people have anemia or other abnormalities of the red blood cells
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http://www.healthcentral.com/diabetes/c ... 1c-level/2
 
Hana, one well controlled type one does not make it right that all type one's should go for low numbers.That is his choice and certainly not the norm of most type one's.

Advising new type one's to go for low numbers is like advising a learner driver to pass an advanced driving course. It just does not happen.
 
I once had an Hba1c of below 5 (exact numbers escape me, but it was around 4.8). the previous months included 2 severe hypo's at work where I was practically asleep at my keyboard, and could barely keep my eyes open. This was followed by memory loss of around 2 weeks of my life followed by a week of severe migraines coupled with panic attacks. When I was finally admitted to hospital I was told I had been hypo for at least a week, if not longer! ok, so I was young, didn't eat as well as I should do and had little desire to test my BG regularly. Ironically, the thing I remember the most is that I lost my memory! My numbers must have been below 4 almost all the time yet I functioned, drove my car even and carried on until my body said 'hang on a minute!!' and started to object. Regular low BG is not good for anyone even if you are used to it. Even if you aren't diabetic :o I accept that some people prefer to be low and even accept that some people aim to be low but it's not for me 8)
 
hanadr said:
What about Fergus?
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If you read the verious posts by Fergus on the different forums, you will find that Fergus hasn't got hypo awareness he open admits this...

Myself my personal thoughts, hypo unawareness is too high a price to pay to achieve a 5% HbA1c, as the ramifications would not only mean that I would put my personal saftey in danger, but would aslo mean I would have to surrender my driving liecence as it is ilegal to hold a driving licence let alone drive a car when ones is aware they are hypo unaware! And being the only one in the household able to drive this poses all sorts of problems for me and my family..
 
frenchkittie said:
Out of interest, which online tool did you use James, as I've just tried one that estimates my HBA1c at 5.45%.
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I use http://beta.glucosebuddy.com/ to log my BG on my ipod touch. Then on the website it calculates what you HbA1c should (theoretically) be. You need at least 90 days worth of readings tho'
 
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