Disappointingly Small Reduction in HbA1c

[Skyrider]

I have been following a low-carb diet (around 100 g/day) for about 6 months & have lost 11 kg in weight, equating to a 15% reduction in body mass.

My initial HbA1c was 45 mmol/mol. I have just received the result of a further blood test, which returned a result of 42 mmol/mol, a reduction of just 3 points.

Whilst the reduction is welcome, it does seem a disappointingly low change in level.

Is this reasonable, or are my expectations too high?

 

[Rachox]

Well done on your reduction in HbA1c and your weight loss. Any reduction in HbA1c should be seen as a success, however if you want to get down into the non diabetic range I guess you could try reducing your carbs still further?

 

[Skyrider]

Well done on your reduction in HbA1c and your weight loss. Any reduction in HbA1c should be seen as a success, however if you want to get down into the non diabetic range I guess you could try reducing your carbs still further?

Thank you for your encouragement. I'm reluctant to cut carbs any further after suffering some issues after a previous attempt at doing so. I also believe that this has been affecting my mood & energy levels. I am now adjusting calories to maintain my current weight as I believe that my weight is now about right.

Maybe if I continue at my current level of carbs there will be a further drop in due course?

I really have no perspective regarding this 3-point drop, whether it is a significant change or an insult to my efforts. I read about people who allegedly drop from 96 to 32 in 3 weeks or so, I wonder who they are kidding?

On the other hand, I only need to drop 1 more point to get back into the normal range, so maybe I should be patient?

 

[KennyA]

It's a fall, that's more than a reasonable start. You don't say what your daily carb intake was before you reduced to 100g - if it wasn't that high you might not see such a dramatic drop. Do you think it's possible that there are any "uncounted" carbs in your food? I discovered a problem with some excellent Ludlow sausages that unfortunately have enough cereal filler to knock me out of ketosis: but the source of those carbs took some tracking down.

If the reported experiences on the forum are any guide it's not really possible to predict how any person will react to low carb, done properly. Some people see immediate BG falls, some don't: some see immediate weight loss, some don't. It's clearly working for you given your large percentage weight loss: you may be one of those people for whom BG reduction follows rather than precedes weight loss (I'm in the other camp).

Stick with it. See what happens.

 

[Resurgam]

@Skyrider I used a glucose meter to check on my after eating levels - but I reduced to 50 gm of carbs a day to get from 91 to 41 in 6 months, and found 50 gm of carbs was keeping my after meal test to under 8 mmol/l. I stuck to the same meals and saw numbers after eating reducing down bit by bit.
I did 91 to 47 in 3 MONTHS without trying very much at all, so perhaps you are misremembering the time taken.
Recently I tried using Tesco shakes and a low calorie diet to try to lower HbA1c and weight - I seem to have lost a bit of weight by my HbA1c went up to 48, so it could be the type of food which is not resulting in lower levels. My suspicion is that the easily accessible carbs in milk and the shakes were causing spikes. Usually my carbs come from salad, raw or cooked veges and berries.
I eat meat, eggs, cheese, fish, full fat dairy for the rest of my requirements, and it is not unusual for me to have steak and mushrooms for breakfast, or a pork chop and stir fry or tinned fish and coleslaw, as back in the mid 18 hundreds, William Banting was pointing out that it was the quality of food which was important for weight loss, just like Dr Atkins in the last century.

 

[Skyrider]

It's a fall, that's more than a reasonable start. You don't say what your daily carb intake was before you reduced to 100g - if it wasn't that high you might not see such a dramatic drop. Do you think it's possible that there are any "uncounted" carbs in your food? I discovered a problem with some excellent Ludlow sausages that unfortunately have enough cereal filler to knock me out of ketosis: but the source of those carbs took some tracking down.

If the reported experiences on the forum are any guide it's not really possible to predict how any person will react to low carb, done properly. Some people see immediate BG falls, some don't: some see immediate weight loss, some don't. It's clearly working for you given your large percentage weight loss: you may be one of those people for whom BG reduction follows rather than precedes weight loss (I'm in the other camp).

Stick with it. See what happens.

I can't say for sure what my carb intake before all this came to light, but given the amount of bread/pasta/rice I was eating I'm sure it would well over 200, so my carb intake now is less than half of what it was before.

I suppose it is possible that there is something in my diet which is hampering my attempts, but I weigh/track everything I eat & drink, so I'm very aware of my macro numbers.

I see that your level came down very quickly when you went keto, but I don't think I could go that far. I'm happy to achieve a slower reduction rate on my present regime, I guess time will tell if it is working or not...

 

[Skyrider]

@Skyrider I used a glucose meter to check on my after eating levels - but I reduced to 50 gm of carbs a day to get from 91 to 41 in 6 months, and found 50 gm of carbs was keeping my after meal test to under 8 mmol/l. I stuck to the same meals and saw numbers after eating reducing down bit by bit.
I did 91 to 47 in 3 MONTHS without trying very much at all, so perhaps you are misremembering the time taken.
Recently I tried using Tesco shakes and a low calorie diet to try to lower HbA1c and weight - I seem to have lost a bit of weight by my HbA1c went up to 48, so it could be the type of food which is not resulting in lower levels. My suspicion is that the easily accessible carbs in milk and the shakes were causing spikes. Usually my carbs come from salad, raw or cooked veges and berries.
I eat meat, eggs, cheese, fish, full fat dairy for the rest of my requirements, and it is not unusual for me to have steak and mushrooms for breakfast, or a pork chop and stir fry or tinned fish and coleslaw, as back in the mid 18 hundreds, William Banting was pointing out that it was the quality of food which was important for weight loss, just like Dr Atkins in the last century.

That's a very impressive reduction in such a short time! I don't currently carry out any kind of regular monitoring. My diet is very similar to your own, albeit without the steak & pork chops. Although I do include slices of beef/chicken/turkey to help with protein levels.

I plan to stick with my current diet for now, in the hope that BG will continue to fall, albeit more slowly than I would like.

I'm aware that stress & poor sleep can influence BG in a negative way; both of these are issues for me, so possibly affecting my results.

 

[Chris24Main]

@Skyrider - I suppose sometimes this site can feel a little like "have you accepted keto as your personal saviour"...

I was very much into scanning, weighing and logging all my macros -
If your current diet is working - by all means stick to it:
I feel more and more that the way we describe "diet" is counter-productive.

You may or may not know that there is a phrase in medical textbooks:
adipose tissue will hypertrophy in the presence of elevated insulin and sufficient energy.

Basically, it means - if both these things are true - high insulin and enough energy in the food - you will be in the game of storing/ locking away fat.
If insulin is low, or your energy level is insufficient, you will free up that fat to burn for energy. (Actually, in this state your body will free up anything it can, including muscle to burn for energy)

And by insufficient - I mean insufficient... your body can cope with huge variations of energy by dialing your metabolism up or down. But - if insulin is high, you are holding on to your fat.

So - your cells get fat because of high insulin. On the same page, there may be an explanation that people get fat because they eat too much. This just doesn't make sense to me [for clarity - I'm only quoting medical textbooks, they may also talk about willpower] - if fat cells "get fat" because of insulin, then people "get fat" because of insulin. So - if you eat in a way that drops insulin - it's simply difficult to hold on to weight. It's a bit of a revelation if you get that - Keto isn't necessary, just reduced insulin. It's then just what everyone used to "know" - sugars and starches are fattening. Not a fad diet at all; only what your granny would have said.

I spent 3 years doing the disciplined calorie counting thing - eventually getting to my "ideal" weight - and being diagnosed diabetic. (long story) - but when I gave up counting calories and ditched the foods that were raising insulin (sugar and starch) - my weight just dropped away to that "ideal" level in about 3 months - and stayed locked there.

If you see it as needing to keep insulin low, then you are left with needing nutrition and energy - which means protein and fat; because if you don't - you are back into lowering energy, and that metabolism dial again.

Having said all that - do what works for you - there is no "right" speed for any of this to happen.

 

[Skyrider]

@Skyrider - I suppose sometimes this site can feel a little like "have you accepted keto as your personal saviour"...

I was very much into scanning, weighing and logging all my macros -
If your current diet is working - by all means stick to it:
I feel more and more that the way we describe "diet" is counter-productive.

You may or may not know that there is a phrase in medical textbooks:
adipose tissue will hypertrophy in the presence of elevated insulin and sufficient energy.

Basically, it means - if both these things are true - high insulin and enough energy in the food - you will be in the game of storing/ locking away fat.
If insulin is low, or your energy level is insufficient, you will free up that fat to burn for energy. (Actually, in this state your body will free up anything it can, including muscle to burn for energy)

And by insufficient - I mean insufficient... your body can cope with huge variations of energy by dialing your metabolism up or down. But - if insulin is high, you are holding on to your fat.

So - your cells get fat because of high insulin. On the same page, there may be an explanation that people get fat because they eat too much. This just doesn't make sense to me [for clarity - I'm only quoting medical textbooks, they may also talk about willpower] - if fat cells "get fat" because of insulin, then people "get fat" because of insulin. So - if you eat in a way that drops insulin - it's simply difficult to hold on to weight. It's a bit of a revelation if you get that - Keto isn't necessary, just reduced insulin. It's then just what everyone used to "know" - sugars and starches are fattening. Not a fad diet at all; only what your granny would have said.

I spent 3 years doing the disciplined calorie counting thing - eventually getting to my "ideal" weight - and being diagnosed diabetic. (long story) - but when I gave up counting calories and ditched the foods that were raising insulin (sugar and starch) - my weight just dropped away to that "ideal" level in about 3 months - and stayed locked there.

If you see it as needing to keep insulin low, then you are left with needing nutrition and energy - which means protein and fat; because if you don't - you are back into lowering energy, and that metabolism dial again.

Having said all that - do what works for you - there is no "right" speed for any of this to happen.

Hi Chris,

Thank you for your interesting & informative reply.

Yes, I get the relationship between insulin & energy. In order to reduce weight, I did reduce calories along with carbs, although I'm aware that the calorie argument is somewhat controversial.

I already suffered from low energy at the time of beginning the diet & I found that reducing my food intake caused me further energy loss together with a lowering of mood.

I think my weight is fine now & my waistline has reduced by about 5" although I still have some of the notorious belly fat which doesn't seem to want to shift. Could this be relevant, maybe an indicator of some remaining visceral fat?

Regards,

Skyrider

 

[Outlier]

Belly fat is often the last to go and sometimes doesn't ever completely leave us. Annoying! But it is an ancient survival mechanism so makes sense.

 

[Skyrider]

Belly fat is often the last to go and sometimes doesn't ever completely leave us. Annoying! But it is an ancient survival mechanism so makes sense.

Hmm, guess I'll survive for a while longer then

 

[Lupf]

Hi @Skyrider congratulations on lowering your weight and your HbA1c.
An HbA1c of 42mmol/mol is the threshold of being prediabetic and at the top end of normal,
@KennyA has a plot with a distribution of healthy HbA1c values, which range up to 42.
Do you have any diabetic symptoms? If not, then I wouldn't worry with an HbA1c of 42.
If you are worried, you could start testing your blood sugar and see how your body reacts to different food.
Regarding diet, do you consider your current diet sustainable in the long run? If so I would stick to it.
As you can see some people on the forum have gone very low carb or keto, but 100 g is low carb
and much lower than a non-diabetic person would consume.
While lowering our HbA1c reduces the risks of diabetic complications, our diet needs to be sustainable.

 

[Skyrider]

Hi @Skyrider congratulations on lowering your weight and your HbA1c.
An HbA1c of 42mmol/mol is the threshold of being prediabetic and at the top end of normal,
@KennyA has a plot with a distribution of healthy HbA1c values, which range up to 42.
Do you have any diabetic symptoms? If not, then I wouldn't worry with an HbA1c of 42.
If you are worried, you could start testing your blood sugar and see how your body reacts to different food.
Regarding diet, do you consider your current diet sustainable in the long run? If so I would stick to it.
As you can see some people on the forum have gone very low carb or keto, but 100 g is low carb
and much lower than a non-diabetic person would consume.
While lowering our HbA1c reduces the risks of diabetic complications, our diet needs to be sustainable.

Thanks Lupf. And congrats to you on lowering your own levels & getting off the Metformin which I believe just gives you a false sense of security anyway.

Interesting how your own HbA1c levels have varied with changes in your weight.

I don't have any diabetic symptoms but I have read enough about the issue to convince me that it's something to avoid, so I'm taking it very seriously. I would feel better if my level dropped more into the normal range.

Yes, I think that my diet is sustainable, although the restriction on carbs sometimes means that I have trouble getting enough fibre & calories (more controversy here!). I think I will stick with my present diet for now & try to improve other factors such as stress/sleep/activity level.

I think I have seen the plot you refer to, but I can't recall if it was referring to 'healthy values' or simply the spread of values among the people tested.

Regards,

Skyrider

 

[KennyA]

@Skyrider these are the HbA1c results for just under 3000 "healthy" non-diabetic individuals.

The mean value is 38 (green line), with a standard deviation of 3 (the bit of the graph in yellow) - that means that almost everyone is clustered within the range 35-41.

 

[Skyrider]

@Skyrider these are the HbA1c results for just under 3000 "healthy" non-diabetic individuals.

The mean value is 38 (green line), with a standard deviation of 3 (the bit of the graph in yellow) - that means that almost everyone is clustered within the range 35-41.

Thanks Kenny, I think that is the one I saw previously. Until a few years ago I was a steady 35, but would be happy (I think) if I could get down to 38!

 

[linda4amici]

][emoji[emoji6]][emoji[emoji6]][emoji[emoji6][emoji6]][emoji[emoji6][emoji6]][emoji[emoji6]]" data-quote="Skyrider" data-source="post: 0" class="bbCodeBlock bbCodeBlock--expandable bbCodeBlock--quote js-expandWatch">

Thanks Kenny, I think that is the one I saw previously. Until a few years ago I was a steady [emoji6], but would be happy (I think) if I could get down to [emoji[emoji6]]!

 

[Melgar]

Hi there @linda4amici , not wanting to derail the thread, so I’ll make it short. Are you using the DCUK app by any chance? I see all the boxed numbers appearing. The app is not functioning, so may I suggest you login via your browser not the app. If you are still having issues just report it or let us know. Mel.