'Correct' HBA1c

Thanks for your interest in the finer details of my physical health, jopar.
I hope you don't mind me putting you straight though? I'm probably in a better position than most to clarify some of the issues for you after all.
I lost my hypo awareness many years ago - back at a time when my HbA1c's were typically around 7%. There is absolutely no truth in your suggestion that this was a result of persistently low blood sugar levels in some misguided attempt to reduce my HbA1c. In fact, if my HbA1c at the time is anything to go by, my bg levels were anything but persistently low. In truth, they fluctuated widely, just as they often do in T1's who eat a lot of carbs and try to balance that with large doses of insulin. My GP called it 'good control', bless him.
Now my HbA1c's over the previous 3 years average at 4.7%. My bg no longer fluctuates wildly anymore, but stays pretty constantly within non-diabetic territory. I have far fewer hypos as a direct result of much more stable, predictable bg patterns. I have some hypo awareness these days, albeit relatively subtle, but frankly the safest insurance policy for any insulin dependant diabetic is a good diet, low doses and frequent testing.
Frankly, I try not to go on about it too much, but I couldn't ignore the implications of your post. I'm quite aware HbA1c's are a concern for many diabetics - usually because they are too high and a fairly reliable predictor of health problems at some point in the future. I have no wish to make others feel uncomfortable about their difficulties in lowering their numbers by posting mine as some kind of unobtainable, or unadvisable, target. After all, I am fortunate enough to have the tools available to me to achieve these numbers - a good diet, insulin, bg meters and an absence of insulin resistance. Others are less fortunate.
I hope that clears things up for you?

fergus

I pleased to say that in almost 22 years of my diabetic career I've not lost any of my hypo-awareness, it remains intact

I to have a good diet and tight control, also not suffered complications a couple of scares that transpired to be nothing of concern.. But like to offer my tactics I use for good control if it works for another good, if it doesn't then hopefully they've learnt something that enables them to find a solutions..

But I am realistic and understand the make-up of the HbA1c and the limitations that it can have as an individual level more so for the Type 1 diabetic... It is a figure that may give an indication that trouble may be ahead if it's high, but it really doesn't tell much about day to day control of diabetes which is more important than HbA1c figure, as it pointless of having a 5% HbA1c if the trade off is increased daily hypo's, high spikes, and the suffering hypo unwareness be this a case of hypo aren't picked up until you are starting to become dangerously low, or not at all causing falling off ones pearch without warning! Much better to have a slightly higher HbA1c of 6% where day to day control is tight that it avoids hypo and spikes and maintains the all important hypo awareness...

I know which one I pefer to chose, but it is an individual choice I must admit, and I do this on a normal diet and a resonable amount of insulin so my choice can't be bad..

It would appear that we all have a different viewpoint on the correct hba1c to reach and maintain.

As I have said in my earlier reply's, I know where I want to be, and when I achieve it I will try my hardest to keep it around that figure. I think there are some amounst us who are dismissive of other peoples control, and the means in which they maintain it.

Take for example Fergus, who has a unbelievable hba1c of 4.7%. I can only admire and respect his determination and discipline in not only reaching this level, but keeping it steady for the last 3 years. Many on this forum, including myself have benefitted from the advice and information that Fergus has kindly provided.

I respect and agree with joper that hba1c does not give the full picture of control, and one which the medical profession and insurance assessors base their judgement on. It is a very crude measurement to determine peoples progress and control, but for now it is all that is to hand. I would prefer to base my control on the previous 3 months readings, but this is time consuming and clinic time doesn't allow for this.

To achieve a hba1c of 6%, by keeping stable control and reducing episodes of hypo's, is where I want to be. I don't want to lose my hypo awareness syptoms for the sake of lowering my hba1c to what some describe as 'non diabetic levels', the risks are to great for me. Therefore, I think that given what has been written so far on this topic, we can all assume and agree that the correct hba1c is purely based on the individual, what they feel comfortable at, and one that takes into account the risks and sacrifices they are willing to make.

Regards

Nigel

jameshallam said:

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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Thanks James, 'though sadly my ipod is of the untouchable variety.

Everyone is slightly different; so most readings have to be adapted to person.
notice acepted range of normal/non-diabetic person.

http://stason.org/TULARC/health/diabetes/20-What-s-HbA1c-and-what-s-it-mean.html

I have found that some places it is said that it is a average of the past 3 months. Please notice the following statements at above link.....

"the HbA1c level represents the average bG level
of approximately the past 4 weeks, strongly weighted toward the most
recent 2 weeks. It is almost entirely insensitive to bG levels more
than 4 weeks previous."

Thus if you have had a "strong episode" ... either hypo or hyper within the last 2 weeks...... it's going to color your HbA1C reading.

I think what we should try and remember is that having a good hba1c is desirable but it doesn't solve everything! You could run your numbers at 9 for 4 weeks and then at 3 for 4 weeks and have an average of 6 - perfect! but it's not perfect, is it?! Having said that you could also run your numbers at 6 all the live long day and have an hba1c of 6 - which again, is perfect! but more 'real' due to the daily testing that HAS to be involved. Bottom line, if you don't test every day (this comment is aimed at type 1's before any type 2's object!) and watch what you eat/inject then you won't be doing yourself any favours. Hba1c is a guide and a useful tool but if you 'cheat' to get the results you want to see, then it's all pretty pointless........ :?

Blimey DB, I'm A T2 and I have no objections to your post. In fact I think it is spot on !!
Frequent daily testing is MUCH more important than any HbA1c readings !
Averages can never be accurate.

cugila said:

Blimey DB, I'm A T2 and I have no objections to your post. In fact I think it is spot on !!
Frequent daily testing is MUCH more important than any HbA1c readings !
Averages can never be accurate.

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well I know that not all Type 2's can get test strips etc without a struggle or they have to pay for them so I didn't want to sound as though I thought everyone can get test strips whenever they like in order to test whenever they like! I have loads but quite right too :wink:

DB.

I have plenty of strips too. I sometimes supplement them as I am using up to 10 a day at the moment. Probably a lot more than most. I think I feel guilty I can get as many as I want with no problems so don't mind putting my hand in my pocket sometimes !

My GP is very good and does listen to reasoned argument, he doesn't think I will get stressed either by frequent testing.

It's interesting to note peoples comments and possibly their interpretation of Bernsteins 'beauty of low numbers' - he wasn't just talking about getting your HbA1c lower (or your fasting BG) it was about (significantly) reducing your carb intake, so that corresponding insulin (T1) or medication (T2) could be reduced. This is not just a gimick to sell books as previously mentioned, it is sound common sense and is used everyday by engineers in the process control industry. Reduce your inputs, reduce the need for large corrections, and oscillations are avoided and control is improved. Its about control and not necessarily low HbA1c. You could use the same principle and target an HbA1c of 6 if you wanted, but the risk of swings becomes greater and the possibility of hitting your target is more difficult the higher that input. (Don't forget the third 'leg' of the stool, exercise, which would also have to be increased in this case)

But for everyone to have a target is important and to be aware of ALL the tools to help them acheive this is critical. Whatever you think of Bernstein and low carb diets the beauty of low numbers is proven fact!

witan said:

It's interesting to note peoples comments and possibly their interpretation of Bernsteins 'beauty of low numbers' - he wasn't just talking about getting your HbA1c lower (or your fasting BG) it was about (significantly) reducing your carb intake, so that corresponding insulin (T1) or medication (T2) could be reduced. This is not just a gimick to sell books as previously mentioned, it is sound common sense and is used everyday by engineers in the process control industry. Reduce your inputs, reduce the need for large corrections, and oscillations are avoided and control is improved. Its about control and not necessarily low HbA1c. You could use the same principle and target an HbA1c of 6 if you wanted, but the risk of swings becomes greater and the possibility of hitting your target is more difficult the higher that input. (Don't forget the third 'leg' of the stool, exercise, which would also have to be increased in this case)

But for everyone to have a target is important and to be aware of ALL the tools to help them acheive this is critical. Whatever you think of Bernstein and low carb diets the beauty of low numbers is proven fact!

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Interesting post! Good point well made but I think what vexes some people about Bernstein is the whole 'you must' low carb mantra when some of us know it is possible to maintain stable/healthy/balanced BG levels without low carbing. As we all know, it's really down to the individual to decide what works for them

witan

But I am not a robot nor any other item that an engineering theory used for..

I don't totally disagree with the small number theory, only the way Berstein has implimented it. He totally ignores the fundemental factor that every human being is different, that our genetic, our emotional, physical and mechinical responces are all different, so the theory should then be applied individual to create individual small number.. But Berstiens assums that his calculations of this theory of 6-12-12 will work for all.

If his theory that using this theroy is correct, which he suggests that it is using himself as the role model, then if you followed his example you would also gain perfect control, but if you take a peek at his forum, you will see others who follow what he says, still struggling and having problems with control I wonder why?

If you put the engineer theory to a car engine, the engineer would reacalulate for each size and type of engine, not assume that the figures for one engine will fit all...

I agree we are all individuals who can determine our own destiny. Most people on the forum however have, or are about to take, some control of their condition, and should be helped to understand all the options and all the risks and then make an informed decision on their target HbA1c and how to acheive that.

Of course we are not machines, we are much more complex than any machine that will ever be produced, and you must remember that Diabetes is not a disease it is a symptom (sweet urine) and has many causes and many variations (some known and documented others yet to be revealed) so I would never propose a single solution to any individual's control.

However for the fun of it (and to wind you up a bit ) you can take the process control analogy one or two steps further. Another technique used is to implement more frequent but smaller inputs/correction - it's much easier to control swings that way too. So instead of having a big carb loaded breakfast before work, have a smaller one and something else mid-morning giving corresponding smaller corrective doses (or exercise) spikes or oscillations are thus reduced.

Of course the other vital aspect of any control system is feedback, if it's automatic then control is pretty straight forward (although all the above is still relevant). But of course for all diabetics that automatic feedback is what's broken (partially (T2) or completely (T1)). So the feedback loop has to be completed with your BG meter and then manual correction with insulin, medication or exercise.

Hypo's of course are in control terms a sort of low level alarm, I'm interested in this concept of 'lost hypo awareness' how common is it in reality? A final comment - what about 'Hyper awareness', the corresponding 'high level alarm', it's a shame this can't kick in at around 6.5. :lol:

witan said:

I'm interested in this concept of 'lost hypo awareness' how common is it in reality?

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Ummm, very common, unfortunately?! I don't know many long term diabetics but the ones I do know have all, without exception, been through a period of hypo unawareness, perhaps more than once in their diabetic lives and you only have to read on this forum to see the high numbers of people who have suffered or are suffering from hypo unawareness. Anyway, hope that answers your question

Deborah (non-robot, real-diabetic :wink: )

Beg to differ there Debs!

Been type 1 for the last 27 years, and always kept my hypo warnings, occasionally they would lessen, so I would run my bg slightly higher to bring them back to normal. In fairness, if anything my hypo awareness syptoms have changed, where once I would sweat and feel shaky, I now feel hungry, bit confused, and need to visit the loo for a piddle! :roll:

So not all people with long-term diabetes lose their hypo awareness. I feel for those who don't have the warning signs, it must be very worrying, and I hope I am never one of one. This is why it is important for all people with diabetes to test their blood glucose regulary to avoid hypo's, and test strips should be available to all, regardless of treatment.

Regards

Nigel

A few years ago when I was in my late 20's, I had just changed over from using animal insulin to the new 'human type' insulin. My dsn at the time told me that that the hypo symptoms I would get from the new insulin would only be mild. She was right in one way but so very wrong as well. It has been well documented that loads of diabetics during the changeover started to complain of loss of awareness when having hypos and many were being taken to hospital being put on glucose drips - myself being one of those.

It was then that I started to complain to my D consultant who told me that with age I would start to lose some of my awareness. I wasn't too pleased so insisted that I got changed back to animal insulin. I was fairly okish with going back but eventually changed to synthetic insulin because my consultant told me that animal insulins were due to be withdrawn so with no choice, I changed. I asked what was causing so many people to have hypos and the answer I got was that the problem was only big with people changing over from animal insulins. The new diabetics starting life off on the synthetics did not have too many problems as their bodies were more able to adapt to the hypo signals that the new insulins were giving.

It has taken me a while to be able to tune in to the warning symptoms that I now get when a hypo is coming on but like Fergus says, they are very subtle and you've got to be on the ball otherwise you could easily miss them especially after you have been diabetic for 20 years or more.

As for driving, yes I do drive. I make sure that I always drive after I have eaten, always do frequent tests and always have something sweetie on the dashboard shelf of my car. I have not felt hypo in a car now for about 15 years and quite frankly probably never will.

noblehead said:

Beg to differ there Debs!

Been type 1 for the last 27 years, and always kept my hypo warnings, occasionally they would lessen, so I would run my bg slightly higher to bring them back to normal. In fairness, if anything my hypo awareness syptoms have changed, where once I would sweat and feel shaky, I now feel hungry, bit confused, and need to visit the loo for a piddle! :roll:

So not all people with long-term diabetes lose their hypo awareness. I feel for those who don't have the warning signs, it must be very worrying, and I hope I am never one of one. This is why it is important for all people with diabetes to test their blood glucose regulary to avoid hypo's, and test strips should be available to all, regardless of treatment.

Regards

Nigel

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I know that everyone is different but the unawareness 'stage' is quite common - guess you're one of the lucky ones Nige!!

Thanks Debs,

Indeed I may count myself lucky, but although I still get good sign's of a hypo, I have to agree with a point that some other members have made in recent posts. The members who have gone back to using animal insulin say that their hypo awareness often returns, or becomes more noticeable than when they were using synthetic insulin.

I have considered switching back to animal insulin for some time, but I am wary of doing so in case it upsets my control, which I have only got stabilised in the last twelve months. As pork/beef insulin takes longer to work, I don't want to experience the high post-meal readings which can happen with slower acting insulin. I wanted to make the switch to try and see if it improved my feeling of lethargy, which doesn't seem to pass whatever I do. As I have ruled out everything else, changing insulin would be my only hope. As I have another ongoing medical complaint that keeps me from sleeping properly, now would not be a good time to change.

To finish, I just want to say that by avoiding hypo's wherever possible ( I know this is not easy) can help to improve hypo awareness. I believe that with frequent hypo's the body becomes use to low blood sugar levels, hence why it stops sending the signals, which as we know all to well, is the last thing we need. I in all honesty test more than ever now, simply to stop a hypo's before it begins, so if I am in the low 4's, I will eat something to stop my blood glucose falling further.

Regards

Nigel

I agree, I am a testing maniac! I am looking forward to getting my pump as even though I will have to test even more than I do now (if that will be possible!) I will hopefully stop the unexplained random highs and lows I get now - I do get warnings now but sometimes when the symptom is confusion it can make things a bit tricky! :lol: I'm confused enough as it is so low BG doesn't help the situation so I'm all for complete avoidance