Type 2 Disappointing HbA1c

[Cellro]

I’ve just had the results back from my blood tests after the first three months of starting 500mg of SR metformin. I’ve lost almost three stone since being diagnosed last summer and eat a low carb diet - I try really hard and am pretty strict. I used a Freestyle Libre 2 free trial in Jan, and first week my levels were good and in range over 70% of the time, then I was made redundant and got a really awful cold that put me in bed for the best part of a week - and readings were suddenly all over the place. Now I’m really disappointed to see that my A1C shows my levels have gone up by three points. I know that looks at previous three months, but could this increase be explained by recent illness and stress? Until now my readings have consistently dropped every time. Has this happened to anyone else? I have a GP appointment next week to review but I’m curious if this could be a factor. My cholesterol has gone up a bit too, but I believe that can happen initially when you lose weight on a low-carb diet.

 

[Outlier]

Illness and stress definitely raise blood glucose, with some of us by rather a lot. So although disappointing for you now, actually considering what you were up against at the time of the test, you've done really well. And the weight loss too - congratulations! Please don't feel despondent, because you are doing a fine job and soon you will see even better results.

 

[Cellro]

Illness and stress definitely raise blood glucose, with some of us by rather a lot. So although disappointing for you now, actually considering what you were up against at the time of the test, you've done really well. And the weight loss too - congratulations! Please don't feel despondent because you are doing a fine job and soon you will see even better results.

Thanks so much for your reply. I’m feeling so disappointed today as I’ve tried so hard. I guess I need to look at the bigger picture and not focus on those numbers quite so much!

 

[Antje77]

Now I’m really disappointed to see that my A1C shows my levels have gone up by three points.

A 3 point (assuming you use mmol/l) difference is basically the same number, sounds like you're pretty stable. It says you were on average about 0.3 mmol/l higher, and lab tests can be slightly different too, like testing your BG twice at the same time and getting slightly different results.

Would you like to share your result? It makes a big difference if you have an hba1c in the 80's or in the 40's.

 

[Cellro]

A 3 point (assuming you use mmol/l) difference is basically the same number, sounds like you're pretty stable. It says you were on average about 0.3 mmol/l higher, and lab tests can be slightly different too, like testing your BG twice at the same time and getting slightly different results.

Would you like to share your result? It makes a big difference if you have an hba1c in the 80's or in the 40's.

Yes, I started out with a reading of 89 during routine tests in June 23. Retested three weeks later in July after starting 8 Week Blood Sugar Diet and it had dropped to 83. At start of Nov it was down to 68 and GP said I was doing well but started me on low dose of metformin. Now it’s 71.

 

[Antje77]

Yes, I started out with a reading of 89 during routine tests in June 23. Retested three weeks later in July after starting 8 Week Blood Sugar Diet and it had dropped to 83. At start of Nov it was down to 68 and GP said I was doing well but started me on low dose of metformin. Now it’s 71.

Yes, I can understand how this is disappointing.
If you're already low carbing, it may be that you need some more medication to help with your diabetes, definitely something to discuss with your HCP.

Would you like to share a typical day of food? Just in case there are some hidden carbs where you don't expect them?
Do you use a glucose meter to test around meals to see what's happening? With an hba1c of 71, your average BG was likely slightly above 11, which is on the disappointing side.

I hope your GP appointment goes well next week!

 

[Cellro]

Yes, I can understand how this is disappointing.
If you're already low carbing, it may be that you need some more medication to help with your diabetes, definitely something to discuss with your HCP.

Would you like to share a typical day of food? Just in case there are some hidden carbs where you don't expect them?
Do you use a glucose meter to test around meals to see what's happening? With an hba1c of 71, your average BG was likely slightly above 11, which is on the disappointing side.

I hope your GP appointment goes well next week!

This is the thing, the Freestyle Libre showed my average at about 9ish, which is why I wondered if the week of illness before the test could have had an impact as I have been testing and monitoring and all seemed well until the crazy up and down readings when I was ill.

As a rule, I have Greek yoghurt with nuts and berries for breakfast, eggs and salad or chicken / leftovers for lunch, and chicken fish or meat with veg for dinner. I don’t eat pasta, rice, bread, potatoes etc (except for v occasional small slice of wholegrain seeded sourdough), have small portions of lentils, beans and pulses a couple of times per week. No processed foods, no alcohol, no snacks, no cakes etc, occasional square of dark chocolate is my only remaining treat. One cup of tea and one coffee per day. No juices or sugary drinks etc.

 

[Antje77]

Doesn't look like your diet is the issue to me.

This is the thing, the Freestyle Libre showed my average at about 9ish, which is why I wondered if the week of illness before the test could have had an impact as I have been testing and monitoring and all seemed well until the crazy up and down readings when I was ill.

Only one week of yoyo-ing shortly before testing could have a small impact (like the 3 point difference you saw).
However, I've used Libre for years, and for me they always read lower than a fingerprick by 1-2 mmol/l, could be the same for you. My Libre predicted hba1c's have always been 8 mmol/mol lower than my lab tests.

You've only been diagnosed recently, it's worth keeping in mind that you might have a different type of diabetes than T2. Not very likely, statistically, but possible.

 

[Cellro]

Doesn't look like your diet is the issue to me.

Only one week of yoyo-ing shortly before testing could have a small impact (like the 3 point difference you saw).
However, I've used Libre for years, and for me they always read lower than a fingerprick by 1-2 mmol/l, could be the same for you. My Libre predicted hba1c's have always been 8 mmol/mol lower than my lab tests.

You've only been diagnosed recently, it's worth keeping in mind that you might have a different type of diabetes than T2. Not very likely, statistically, but possible.

That’s interesting, thanks. Mine didn’t seem to be all that far out so I expected a small drop - perhaps the illness and stress was enough to throw it out a bit. I wasn’t quite as strict over Christmas but I didn’t go mad by any stretch.

 

[LittleGreyCat]

HbA1c is a measure over 3 months, but it is most impacted by the last 6 weeks.
So abnormal BG in the few weeks before the test can have a disproportionate impact.
You seem to be doing all the right things, so well done!

Diabetes is a marathon not a sprint, so you have to be patient with yourself.
Keep on doing the good stuff and see what your next results are.