GP says HbA1c 0f 46 is too low

Oldvatr said:

Just had my annual review, and my HbA1c was 46 which is one click up from last year, GP told me it is too low, and that he wants the next one to be 56 or higher. This equates to a daily average of 9 mmol.l, I pushed back, and he cut my Dapagliflozin med that had been prescribed for my heart. This is on top of withdrawing my Metformin completely last year. I asked for more gliclazide since I had secretly been trialling some to get my HbA1c back to 42. But NO. He wants 56 because his recent refresher course says this is what patients over the age of 70 should be advised to go for. Buzzcocks. I could not find any UK directive supporting this change, but did find a US advisory
https://www.arkansasonline.com/news/2019/apr/29/lower-blood-sugar-is-not-always-the-bes/

Looks like I will need to go keto or carnivore now. That will make my eGFR worse, of course because of the extra creatine. I am also cutting out the furusomide since that med is definitely raising my blood sugar level, and giving me constipation.

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Oldvatr said:

I wonder who is teaching the teachers this. I suspect it is the old ageist attitude that most elderly people are too frail or get too obsessive etc. Same reasonng behind the No Home Tessting for us T2D. Even more confusing since the US article goes on about poor kidney function leading to hypo's which is another nugget of unknown source.

OK we were both wrong NICE has amended the guidelines, as copied here
https://www.nice.org.uk/guidance/ng28/chapter/Recommendations#blood-glucose-management
I am on Gliclazide, so my target according to NICE should be 53 (not 56 as stated by my GP) Its still buzzcocks since the lowest reading I saw in the last year was 4.6, which is nowhere near hypo.

I note that the guidelines now state that SGLT-2 should NOT be used with a low carb or keto diet. They say the diet must change before taking an SGLT-2.

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Oldvatr said:

Just had my annual review, and my HbA1c was 46 which is one click up from last year, GP told me it is too low, and that he wants the next one to be 56 or higher. This equates to a daily average of 9 mmol.l, I pushed back, and he cut my Dapagliflozin med that had been prescribed for my heart. This is on top of withdrawing my Metformin completely last year. I asked for more gliclazide since I had secretly been trialling some to get my HbA1c back to 42. But NO. He wants 56 because his recent refresher course says this is what patients over the age of 70 should be advised to go for. Buzzcocks. I could not find any UK directive supporting this change, but did find a US advisory
https://www.arkansasonline.com/news/2019/apr/29/lower-blood-sugar-is-not-always-the-bes/

Looks like I will need to go keto or carnivore now. That will make my eGFR worse, of course because of the extra creatine. I am also cutting out the furusomide since that med is definitely raising my blood sugar level, and giving me constipation.

Click to expand...

Oldvatr said:

Just had my annual review, and my HbA1c was 46 which is one click up from last year, GP told me it is too low, and that he wants the next one to be 56 or higher. This equates to a daily average of 9 mmol.l, I pushed back, and he cut my Dapagliflozin med that had been prescribed for my heart. This is on top of withdrawing my Metformin completely last year. I asked for more gliclazide since I had secretly been trialling some to get my HbA1c back to 42. But NO. He wants 56 because his recent refresher course says this is what patients over the age of 70 should be advised to go for. Buzzcocks. I could not find any UK directive supporting this change, but did find a US advisory
https://www.arkansasonline.com/news/2019/apr/29/lower-blood-sugar-is-not-always-the-bes/

Looks like I will need to go keto or carnivore now. That will make my eGFR worse, of course because of the extra creatine. I am also cutting out the furusomide since that med is definitely raising my blood sugar level, and giving me constipation.

Click to expand...

JohnEGreen said:

It's all crazy my diabetic nurse because I was achieving normal range blood glucose levels changed my classification to in remission the next thing that happened was I got a letter from the diabetic eye screening service to say I no longer qualify for the annual dibetic eye test all this based on levels I was getting prior to covid since I had covid my levels have increased but according to NICE she should have told me my HbA1c was too low and to eat more carbs.

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mansingh01 said:

That’s a prefect number

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