Falling HbA1c

I am Type 2. But this article may be timely

https://www.diabetesdaily.com/blog/can-your-a1c-be-too-low-569453/

Unfortunately, it appears that some practitioners still operate on the assumption that if a person with diabetes has achieved a normal A1c level (i.e., 4.5 – 5.6%), the patient must be experiencing frequent and/or severe hypoglycemic episodes. Of course, this way of thinking is short-sighted. The patient’s time in range and risk of severe hypoglycemia must be considered to have a full understanding of the scope of control to make the appropriate recommendation.

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He's worried that a low hbA1C will result in you losing hypo awareness, which is really bad news. This happened to me both times I was pregnant and kept my HbA1C to low (less than 6) levels.

Bad hypos can kill you.

EllieM said:

He's worried that a low hbA1C will result in you losing hypo awareness, which is really bad news. This happened to me both times I was pregnant and kept my HbA1C to low (less than 6) levels.

Bad hypos can kill you.

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Having said that, I don't see the problem if hypos aren't proving difficult, and you can also regain hypo awareness by raising your blood sugars for a while. The risk is that your first bad hypo might kill you, I guess.

Also, now that cgms are available, it's much easier to avoid hypos, bad or otherwise.... Not sure if the doctors have factored this into their calculations yet.

How often do you test your blood sugars? How often do you have lows, and in particular how often do you have severe lows (< 3) ? The main concern with a low HbA1c is that it is a combination of bad highs and lows which cancel each other out, but if you are not having frequent or severe hypos then it is not dangerous. I have gotten HbA1c's between 4.6 and 5.5 since I was diagnosed, endo was not happy with the 4.6 but has always been pleased with the 5's.

Raj2512 said:

That's what the doctor also felt (maybe I am getting hypos) but I'm not. Anyway, have decided to raise my sugars for a while and check again the levels next month.

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If you feel you're not getting hypos you could ask to be put on a cgm for a week to demonstrate.... It's the potential lows at night that they're most worried about. If the doctors won't lend you a cgm for a week you could consider self funding a libre, but be aware that it isn't accurate for everyone.

I’d definitely second the suggestion that you get a CGM so you can make sure you’re not having any hypos - and to prove to them that you’re not. You’re doing great, by the way!

I’m having a similar argument with my practice nurse at my GP surgery - my last HbA1c came back at 6.1% and she wants me to raise it to 7 because I’ve “got to be having lots of hypos” - I’ve got to go for hypo awareness training next week because she didn’t believe me - or that after 20 years of T1 I was well aware of what a hypo feels like. So I’ll go armed with all my CGM graphs so I can show them categorically that I’m not.

I’m aiming for 5s next time